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05 11, 2022;12 (5): e050021.

Randomised controlled trials on prevention, diagnosis and treatment of diabetes in African countries: a systematic review.

Angelika Sabine Sandholzer-Yilmaz, Eric Sven Kroeber, Wondimu Ayele, T Frese, Eva Johanna Kantelhardt, Susanne Unverzagt
Author Information
  1. Angelika Sabine Sandholzer-Yilmaz: Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle, Germany angelika.sandholzer@med.uni-goettingen.de. ORCID
  2. Eric Sven Kroeber: Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle, Germany. ORCID
  3. Wondimu Ayele: Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
  4. T Frese: Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle, Germany.
  5. Eva Johanna Kantelhardt: Institute for Medical Epidemiology, Biostatistics and Informatics, Center of Health Sciences, Martin-Luther-University Halle-Wittenberg Medical Faculty, Halle, Germany. ORCID
  6. Susanne Unverzagt: Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle, Germany. ORCID
PMID: 35545395 DOI: 10.1136/bmjopen-2021-050021

Abstract

OBJECTIVES: The epidemiological transition from infectious to chronic diseases leads to novel challenges in African health systems. The prevalence of diabetes mellitus (DM) is increasing dramatically. Undiagnosed and undertreated DM leads to numerous complications including end-organ damage and death. Our objectives were to collect the best locally generated evidence on DM interventions, identify knowledge gaps and determine underexplored research areas.
DESIGN: A systematic review and meta-analysis of randomised controlled trials.
PARTICIPANTS AND SETTING: African patients in primary, secondary and tertiary prevention, diagnosis and treatment DM type 1 (DM1), type 2 (DM2) and gestational DM (GDM).
OUTCOME: All-cause mortality, glycaemic control, complications, quality of life, hospital admission, treatment adherence and costs.
DATA SOURCES: Articles published in MEDLINE Ovid, CENTRAL, CINAHL, African Journals Online and African Index Medicus and the International Clinical Trials Registry Platform in English language without time restrictions. The systematic search was last updated in October 2020.
RESULTS: Out of 3736 identified publications, we included 60 eligible studies conducted in 15 countries, 75% were conducted in urban healthcare settings, including 10 112 participants. We included 8 studies on DM1, 6 on GDM, 2 on pre-DM, 37 on mainly DM2 including 7 on DM-related complications. The design of the studied intervention was heterogeneous with a focus on educational strategies. The other studies investigated the efficacy of nutritional strategies including food supplementations, pharmacological strategies and strategies to enhance physical activity. Seven studies included interventions on DM-related complications.
CONCLUSIONS: Research activities increased in recent years, but available evidence is still not representative for all African countries. There is a big lack of evidence in primary healthcare and rural settings, implementation research, pharmacological interventions, especially in poorer countries. Nevertheless, the identified studies offer a variety of effective interventions that can inform medical care and future research.
PROSPERO REGISTRATION NUMBER: CRD42019122785.

Keywords

diabetes & endocrinology diabetes in pregnancy general diabetes

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MeSH Term

Chronic Disease
Diabetes Mellitus, Type 1
Diabetes, Gestational
Exercise
Female
Humans
Pregnancy
Quality of Life
Randomized Controlled Trials as Topic
Journal Article Meta-Analysis Systematic Review
Article has an altmetric score of 2

Word Cloud

Created with Highcharts 10.0.0AfricandiabetesDMstudiescomplicationsincludinginterventionsstrategiesevidenceresearchsystematictreatmentincludedcountriesleadsreviewcontrolledtrialsprimarypreventiondiagnosistypeDM12DM2GDMidentifiedconductedhealthcaresettingsDM-relatedpharmacologicalOBJECTIVES:epidemiologicaltransitioninfectiouschronicdiseasesnovelchallengeshealthsystemsprevalencemellitusincreasingdramaticallyUndiagnosedundertreatednumerousend-organdamagedeathobjectivescollectbestlocallygeneratedidentifyknowledgegapsdetermineunderexploredareasDESIGN:meta-analysisrandomisedPARTICIPANTSANDSETTING:patientssecondarytertiary1gestationalOUTCOME:All-causemortalityglycaemiccontrolqualitylifehospitaladmissionadherencecostsDATASOURCES:ArticlespublishedMEDLINEOvidCENTRALCINAHLJournalsOnlineIndexMedicusInternationalClinicalTrialsRegistryPlatformEnglishlanguagewithouttimerestrictionssearchlastupdatedOctober2020RESULTS:3736publications60eligible1575%urban10112participants86pre-DM37mainly7designstudiedinterventionheterogeneousfocuseducationalinvestigatedefficacynutritionalfoodsupplementationsenhancephysicalactivitySevenCONCLUSIONS:ResearchactivitiesincreasedrecentyearsavailablestillrepresentativebiglackruralimplementationespeciallypoorerNeverthelessoffervarietyeffectivecaninformmedicalcarefuturePROSPEROREGISTRATIONNUMBER:CRD42019122785Randomisedcountries:&endocrinologypregnancygeneral

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