Community-based educational interventions for prevention of type II diabetes: a global systematic review and meta-analysis

Tayebeh Shirvani, Zeinab Javadivala, Somayeh Azimi, Abdolreza Shaghaghi, Zahra Fathifar, H D R Devender Bhalla, Mohammadhiwa Abdekhoda, Haidar Nadrian, Tayebeh Shirvani, Zeinab Javadivala, Somayeh Azimi, Abdolreza Shaghaghi, Zahra Fathifar, H D R Devender Bhalla, Mohammadhiwa Abdekhoda, Haidar Nadrian

Abstract

Purpose: Our objective was to estimate the change in community-based education interventions throughout the world that may effectuate in risk parameters of type II diabetes (T2D), including the diabetes incidence rate, fasting blood glucose, hemoglobin A1C, body mass index, waist circumference, and systolic and diastolic blood pressure.

Methods: A comprehensive search for globally eligible studies was conducted on PubMed, Embase, ProQuest, CINAHL nursing & allied health source, Cochrane Library, Google Scholar, conference proceedings, and reference lists. Data were extracted using JBI standardized data extraction tool. The primary outcome variables were diabetes incidence rate, fasting blood sugar (FBS), hemoglobin A1c (HbAlc), body mass index (BMI), waist circumference (WC), systolic/diastolic blood pressure (s/d BP). Random-effects meta-analysis and sub-group analyses were conducted.

Results: Nineteen interventional studies were included in the review, and ten studies were pooled in the meta-analysis (n = 16,106, mean age = 41.5 years). The incidence rate of T2D was reported in three trials, within which the risk of developing T2D was reduced by 54.0% in favor of community-based educational interventions, (RR = 0.54, 95% CI = 0.38-0.75; p < 0.001). In eleven (n = 11,587) and six (n = 6416) studies, the pooled mean differences were - 0.33 (95% CI: - 0.45 to - 0.20, p < 0.0001) and - 0.15 (95% CI: - 0.28 to - 0.03, p < 0.0001) for FBS and HbA1c levels, respectively. Positive significant effects were observed on reducing BMI [pooled mean difference = - 0.47 (95% CI: - 0.66 to - 0.28), I2 = 95.7%, p < 0.0001] and WC [pooled mean difference = - 0.66 (95% CI: - 0.89 to - 0.43), I2 = 97.3%, p < 0.0001]. The use of theoretical frameworks was found to provide a 48.0% change in fasting blood sugar.

Conclusions: Based on a comprehensive data collection of about 16,106 participants and reasonable analyses, we conclude that educational interventions may reduce diabetes incidence by 54.0%, particularly through reductions in fasting blood glucose, body mass index, and waist circumference. The diabetes risk parameters may favorably improve irrespective of the duration of intervention, at as low as 6 months. The application of theoretical frameworks while designing educational interventions is also encouraged.

Systematic review registration: PROSPERO CRD42018115877.

Keywords: Behavior change; Community-based; Diabetes; Educational intervention; Epidemiology; Prevention.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart describing the pathway to search of community-based studies that had education as an intervention for the prevention of diabetes
Fig. 2
Fig. 2
Meta-analysis results showing the effect of diabetes interventions on diabetes incidence (a), HBA1c level (b), body mass index (c), waist circumstance (d), and diastolic (e) and systolic (f) blood pressure
Fig. 3
Fig. 3
Subgroup meta-analysis results showing the effect of diabetes interventions on fasting blood glucose levels based on the duration of follow-up (a), gender (b), age (c), and using theoretical framework for designing their interventions (d)
Fig. 4
Fig. 4
Funnel plots showing the effects of heterogeneity and publication bias in studies that addressed the prevention of diabetes through interventions for effecting change in the fasting blood glucose (a) and hemoglobin A1c (b) levels

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