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Open Access Research article

Characteristics and effectiveness of diabetes self-management educational programs targeted to racial/ethnic minority groups: a systematic review, meta-analysis and meta-regression

Ignacio Ricci-Cabello12*, Isabel Ruiz-Pérez23, Antonio Rojas-García23, Guadalupe Pastor3, Miguel Rodríguez-Barranco3 and Daniela C Gonçalves1

Author Affiliations

1 Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, 2nd floor, Walton Street, Jericho OX2 6NW, UK

2 CIBER en Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain

3 Andalusian School of Public Health, Granada, Spain

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BMC Endocrine Disorders 2014, 14:60  doi:10.1186/1472-6823-14-60

Published: 19 July 2014

Abstract

Background

It is not clear to what extent educational programs aimed at promoting diabetes self-management in ethnic minority groups are effective. The aim of this work was to systematically review the effectiveness of educational programs to promote the self-management of racial/ethnic minority groups with type 2 diabetes, and to identify programs’ characteristics associated with greater success.

Methods

We undertook a systematic literature review. Specific searches were designed and implemented for Medline, EMBASE, CINAHL, ISI Web of Knowledge, Scirus, Current Contents and nine additional sources (from inception to October 2012). We included experimental and quasi-experimental studies assessing the impact of educational programs targeted to racial/ethnic minority groups with type 2 diabetes. We only included interventions conducted in countries members of the OECD. Two reviewers independently screened citations. Structured forms were used to extract information on intervention characteristics, effectiveness, and cost-effectiveness. When possible, we conducted random-effects meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. Two reviewers independently extracted all the information and critically appraised the studies.

Results

We identified thirty-seven studies reporting on thirty-nine educational programs. Most of them were conducted in the US, with African American or Latino participants. Most programs obtained some benefits over standard care in improving diabetes knowledge, self-management behaviors and clinical outcomes. A meta-analysis of 20 randomized controlled trials (3,094 patients) indicated that the programs produced a reduction in glycated hemoglobin of -0.31% (95% CI -0.48% to -0.14%). Diabetes knowledge and self-management measures were too heterogeneous to pool. Meta-regressions showed larger reduction in glycated hemoglobin in individual and face to face delivered interventions, as well as in those involving peer educators, including cognitive reframing techniques, and a lower number of teaching methods. The long-term effects remain unknown and cost-effectiveness was rarely estimated.

Conclusions

Diabetes self-management educational programs targeted to racial/ethnic minority groups can produce a positive effect on diabetes knowledge and on self-management behavior, ultimately improving glycemic control. Future programs should take into account the key characteristics identified in this review.

Keywords:
Diabetes type 2; Self-management; Educational interventions; Systematic literature review; Meta-analysis; Meta-regression