Bianco Laura, Uranga Sofía I, Rodriguez Alexander W, Shetty Raj, Staab Erin M, Franco-Galicia Melissa I, Deckard Amber N, Thomas Nikita C, Wan Wen, Alexander Jason T, Baig Arshiya A, Laiteerapong Neda
Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL 60208, USA.
Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
Int J Environ Res Public Health. 2025 Aug 28;22(9):1345. doi: 10.3390/ijerph22091345.
Hispanic populations in the U.S. have a high prevalence of type 2 diabetes and its complications. It has been proposed that interventions targeting multiple levels and domains of influence are needed to address health disparities, but more evidence is needed regarding the most effective approaches. We aimed to review the effects of non-pharmacological interventions on glycemic control among Hispanic persons with diabetes, overall and by level and domain of intervention. A systematic review (PubMed, Scopus, PsycInfo, CINAHL; 1985-2019) identified randomized trials reporting HbA1c outcomes for Hispanic populations. Article review, data extraction, and risk of bias assessment were completed by independent reviewers. Level and domain of intervention were assigned based on the National Institute on Minority Health and Health Disparities Research Framework. Random-effects meta-analyses estimated pooled effect sizes. Quality of evidence was rated based on the GRADE framework. Forty-eight trials met inclusion criteria, representing various Hispanic populations ( = 18 Mexican, = 5 Puerto Rican, = 1 Dominican, = 4 multiple, = 20 unspecified) and enrolling 9185 total participants. Overall, interventions decreased HbA1c by -0.32% (95% CI: -0.44% to -0.20%, I = 68%, strength of evidence: moderate). Multi-level, multi-domain interventions decreased HbA1c by -0.41% (-0.61% to -0.21%, I = 74%, strength of evidence: moderate). Few interventions addressed community ( = 3), society ( = 0), or physical/built environment ( = 1). Non-pharmacological interventions have modestly decreased HbA1c among Hispanic persons with diabetes. Multi-level, multi-domain interventions are promising, but more research is needed on interventions that target social and environmental structures.
美国的西班牙裔人群中2型糖尿病及其并发症的患病率很高。有人提出，需要针对多个影响层面和领域进行干预，以解决健康差距问题，但对于最有效的方法还需要更多证据。我们旨在综述非药物干预对西班牙裔糖尿病患者血糖控制的影响，总体情况以及按干预层面和领域进行分析。一项系统综述（PubMed、Scopus、PsycInfo、CINAHL；1985 - 2019年）确定了报告西班牙裔人群糖化血红蛋白（HbA1c）结果的随机试验。由独立评审员完成文章评审、数据提取和偏倚风险评估。根据美国国立少数族裔健康与健康差距研究所的研究框架确定干预的层面和领域。随机效应荟萃分析估计合并效应量。根据GRADE框架对证据质量进行评级。48项试验符合纳入标准，涉及不同的西班牙裔人群（18项针对墨西哥裔、5项针对波多黎各裔、1项针对多米尼加裔、4项针对多个群体、20项未明确），共纳入9185名参与者。总体而言，干预措施使糖化血红蛋白降低了0.32%（95%置信区间：-0.44%至-0.20%，I² = 68%，证据强度：中等）。多层面、多领域干预措施使糖化血红蛋白降低了0.41%（-0.61%至-0.21%，I² = 74%，证据强度：中等）。很少有干预措施涉及社区层面（3项）、社会层面（0项）或物理/建筑环境层面（1项）。非药物干预措施适度降低了西班牙裔糖尿病患者的糖化血红蛋白水平。多层面、多领域干预措施很有前景，但针对社会和环境结构的干预措施还需要更多研究。
