Improving management of type 2 diabetes in South Asian patients: a systematic review of intervention studies.
OBJECTIVE
Optimal control of type 2 diabetes is challenging in many patient populations including in South Asian patients. We systematically reviewed studies on the effect of diabetes management interventions targeted at South Asian patients with type 2 diabetes on glycaemic control.


METHODS
Systematic review of MEDLINE, EMBASE and CINAHL databases for randomised controlled trials (RCTs) and pre-post-test studies (January 1990 to February 2014). Studies were stratified by where interventions were conducted (South Asia vs Western countries).


METHODS
Patients originating from Pakistan, Bangladesh or India with type 2 diabetes.


METHODS
Change in glycated haemoglobin (HbA1c). Secondary end points included change in blood pressure, lipid levels, anthropomorphics and knowledge.


RESULTS
23 studies (15 RCTs) met criteria for analysis with 7 from Western countries (n=2532) and 16 from South Asia (n=1081). Interventions in Western countries included translated diabetes education, additional clinical care, written materials, visual aids, and bilingual community-based peers and/or health professionals. Interventions conducted in South Asia included yoga, meditation or exercise, community-based peers, health professionals and dietary education (cooking exercises). Among RCTs in India (5 trials; n=390), 4 demonstrated significant reductions in HbA1c in the intervention group compared with usual care (yoga and exercise interventions). Among the 4 RCTs conducted in Europe (n=2161), only 1 study, an education intervention of 113 patients, reported a significant reduction in HbA1c with the intervention. Lipids, blood pressure and knowledge improved in both groups with studies from India more often reporting reductions in body mass index and waist circumference.


CONCLUSIONS
Overall, there was little improvement in HbA1c level in diabetes management interventions targeted at South Asians living in Europe compared with usual care, although other outcomes did improve. The smaller studies in India demonstrated significant improvements in glycaemic and other end points. Novel strategies are needed to improve glycaemic control in South Asians living outside of India.
College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
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Bhurji
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Javer
College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
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D
Gasevic
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.
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Khan
D044466:Asian People; D001459:Bangladesh / Q000208:ethnology; D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000628:therapy*; D019468:Disease Management; D005060:Europe / Q000453:epidemiology; D015444:Exercise; D006442:Glycated Hemoglobin / Q000032:analysis; D015438:Health Behavior; D006801:Humans; D007194:India / Q000208:ethnology; D010154:Pakistan / Q000208:ethnology; D016032:Randomized Controlled Trials as Topic; D012648:Self Care; D015013:Yoga
D001786:Blood Glucose; D006442:Glycated Hemoglobin
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