Effective primary care management of type 2 diabetes for indigenous populations: A systematic review

Chopra, Sahil, Lahiff, Tahne Joseph, Franklin, Richard, Brown, Alex, and Rasalam, Roy (2022) Effective primary care management of type 2 diabetes for indigenous populations: A systematic review. PLoS ONE, 17 (11). e0276396.

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Background: Indigenous peoples in high income countries are disproportionately affected by Type 2 Diabetes. Socioeconomic disadvantages and inadequate access to appropriate healthcare are important contributors.

Objectives: This systematic review investigates effective designs of primary care management of Type 2 Diabetes for Indigenous adults in Australia, Canada, New Zealand, and the United States. Primary outcome was change in mean glycated haemoglobin. Secondary outcomes were diabetes-related hospital admission rates, treatment compliance, and change in weight or Body Mass Index.

Methods: Included studies were critically appraised using Joanna Briggs Institute appraisal checklists. A mixed-method systematic review was undertaken. Quantitative findings were compared by narrative synthesis, meta-aggregation of qualitative factors was performed.

Results: Seven studies were included. Three reported statistically significant reductions in means HbA1c following their intervention. Seven components of effective interventions were identified. These were: a need to reduce health system barriers to facilitate access to primary care (which the other six components work towards), an essential role for Indigenous community consultation in intervention planning and implementation, a need for primary care programs to account for and adapt to changes with time in barriers to primary care posed by the health system and community members, the key role of community-based health workers, Indigenous empowerment to facilitate community and self-management, benefit of short-intensive programs, and benefit of group-based programs.

Conclusions: This study synthesises a decade of data from communities with a high burden of Type 2 Diabetes and limited research regarding health system approaches to improve diabetes-related outcomes. Policymakers should consider applying the seven identified components of effective primary care interventions when designing primary care approaches to mitigate the impact of Type 2 Diabetes in Indigenous populations. More robust and culturally appropriate studies of Type 2 Diabetes management in Indigenous groups are needed.

Item ID: 76940
Item Type: Article (Research - C1)
ISSN: 1932-6203
Keywords: type 2 diabetes; indigenous; diabetes management
Copyright Information: Copyright: © 2022 Chopra et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Date Deposited: 05 Dec 2022 22:54
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320208 Endocrinology @ 20%
45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450409 Aboriginal and Torres Strait Islander health services @ 60%
42 HEALTH SCIENCES > 4203 Health services and systems > 420304 General practice @ 20%
SEO Codes: 21 INDIGENOUS > 2103 Aboriginal and Torres Strait Islander health > 210303 Aboriginal and Torres Strait Islander health system performance @ 40%
21 INDIGENOUS > 2199 Other Indigenous > 219999 Other Indigenous not elsewhere classified @ 30%
20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 30%
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