BACKGROUND Racial and ethnic disparities in type 2 diabetes outcomes are a major public health concern. Interventions targeting multiple barriers may help address disparities. PURPOSE To conduct a systematic review and meta-analysis of diabetes self-management education (DSME) interventions in minority populations. We hypothesized that interventions addressing multiple levels (individual, interpersonal, community, and societal) and/or domains (biological, behavioral, physical/built environment, sociocultural environment, and health care system) would have the greatest effect on hyperglycemia. DATA SOURCES We performed an electronic search of research databases PubMed, Scopus, CINAHL, and PsycINFO (1985–2019). STUDY SELECTION We included randomized controlled trials of DSME interventions among U.S. adults with type 2 diabetes from racial and ethnic minority populations. DATA EXTRACTION We extracted study parameters on DSME interventions and changes in percent hemoglobin A1c (HbA1c). DATA SYNTHESIS A total of 106 randomized controlled trials were included. Twenty-five percent (n = 27) of interventions were exclusively individual-behavioral, 51% (n = 54) were multilevel, 66% (n = 70) were multidomain, and 42% (n = 45) were both multilevel and multidomain. Individual-behavioral interventions reduced HbA1c by −0.34 percentage points (95% CI −0.46, −0.22; I2 = 33%) (−3.7 [−5.0, −2.4] mmol/mol). Multilevel interventions reduced HbA1c by −0.40 percentage points (95% CI −0.51, −0.29; I2 = 68%) (−4.4 [−5.6, −3.2] mmol/mol). Multidomain interventions reduced HbA1c by −0.39 percentage points (95% CI −0.49, −0.29; I2 = 68%) (−4.3 [−5.4, −3.2] mmol/mol). Interventions that were both multilevel and multidomain reduced HbA1c by −0.43 percentage points (95% CI −0.55, −0.31; I2 = 69%) (−4.7 [−6.0, −3.4] mmol/mol). LIMITATIONS The analyses were restricted to RCTs. CONCLUSIONS Multilevel and multidomain DSME interventions had a modest impact on HbA1c. Few DSME trials have targeted the community and society levels or physical environment domain. Future research is needed to evaluate the effects of these interventions on outcomes beyond HbA1c.

中文翻译：

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多层次和多领域干预措施改善美国少数族裔人群血糖控制的有效性：系统评价和荟萃分析


背景技术 2 型糖尿病结局的种族和民族差异是一个主要的公共卫生问题。针对多重障碍的干预措施可能有助于解决差距。目的 对少数群体中的糖尿病自我管理教育 (DSME) 干预措施进行系统评价和荟萃分析。我们假设针对多个层面（个人、人际、社区和社会）和/或领域（生物、行为、物理/建筑环境、社会文化环境和医疗保健系统）的干预措施将对高血糖产生最大的影响。数据来源我们对研究数据库 PubMed、Scopus、CINAHL 和 PsycINFO (1985-2019) 进行了电子检索。研究选择 我们纳入了针对美国少数族裔 2 型糖尿病成人患者进行 DSME 干预的随机对照试验。数据提取 我们提取了 DSME 干预措施和糖化血红蛋白百分比 (HbA1c) 变化的研究参数。数据综合 总共纳入 106 项随机对照试验。 25% (n = 27) 的干预措施完全是个人行为干预，51% (n = 54) 是多层次的，66% (n = 70) 是多领域的，42% (n = 45) 是多层次和多领域的。个体行为干预使 HbA1c 降低了 −0.34 个百分点 (95% CI −0.46, −0.22; I2 = 33%) (−3.7 [−5.0, −2.4] mmol/mol)。多级干预使 HbA1c 降低了 −0.40 个百分点 (95% CI −0.51, −0.29; I2 = 68%) (−4.4 [−5.6, −3.2] mmol/mol)。多域干预使 HbA1c 降低了 −0.39 个百分点 (95% CI −0.49, −0.29; I2 = 68%) (−4.3 [−5.4, −3.2] mmol/mol)。多层次和多领域的干预措施使 HbA1c 降低了 -0.43 个百分点（95% CI -0.55，-0.55）。31； I2 = 69%) (−4.7 [−6.0, −3.4] mmol/mol)。局限性分析仅限于随机对照试验。结论 多层次和多领域 DSME 干预措施对 HbA1c 的影响不大。很少有 DSME 试验针对社区和社会层面或物理环境领​​域。未来的研究需要评估这些干预措施对 HbA1c 以外的结果的影响。