Effectiveness of Diabetes Self-Management Education and Support on Glycemic Control and Diabetes-Related Outcomes in Africa: A Systematic Review and Meta-Analysis

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Abstract

INTRODUCTION: Diabetes prevalence in Africa continues to rise, presenting significant health and economic challenges. Effective management strategies, such as diabetes self-management education and support, are crucial for improving clinical outcomes. However, the impact of diabetes self-management education and support on glycemic control and related metabolic parameters in African populations remains unclear. This study evaluates the effectiveness of diabetes self-management education and support interventions compared with that of standard diabetes care in Africa, with a focus on glycemic control and secondary metabolic outcomes. METHODS: A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. Comprehensive searches were performed in PubMed, Embase, CINAHL, Scopus, Web of Science, and PsycINFO, supplemented with regional sources such as Africa Journal Online and ProQuest. RCTs published in English up to April 2024, involving adult participants with Type 2 diabetes in Africa who received diabetes self-management education and support interventions, were included. The Cochrane Risk of Bias Tool 1 was used to assess study quality. Heterogeneity was evaluated using I² statistics, and random-effects models were applied for pooled estimates. RESULTS: Eighteen RCTs (2,599 participants) were included. diabetes self-management education and support interventions did not significantly improve glycemic control, with a pooled mean reduction in HbA1c of -0.25% (95% CI= -0.68, 0.18; p<0.0001). Fasting blood glucose outcomes, assessed in 2 studies, showed no significant difference (mean difference= -0.13, 95% CI= -0.37, 0.12). Secondary outcomes (BMI, blood pressure, lipids) showed no significant changes. Sensitivity analysis excluding 1 study showed a larger effect size (-0.42%, 95% CI= -0.76, -0.07). Substantial heterogeneity (I²=93.8%) was observed. CONCLUSIONS: Diabetes self-management education and support reveals a nonsignificant impact on HbA1c reduction in African adults with Type 2 diabetes and emphasizes the need for more standardized approaches and broader outcome measures. Future studies should aim to refine diabetes self-management education and support models, enhance patient engagement, and evaluate a wider range of health outcomes to realize the full potential of diabetes self-management education and support in resource-limited settings.

Abstract as published, via PubMed.