PMID- 30709362
OWN - NLM
STAT- MEDLINE
DCOM- 20190226
LR  - 20231005
IS  - 1744-8603 (Electronic)
IS  - 1744-8603 (Linking)
VI  - 15
IP  - 1
DP  - 2019 Feb 1
TI  - The effect of community-based programs on diabetes prevention in low- and 
      middle-income countries: a systematic review and meta-analysis.
PG  - 10
LID - 10.1186/s12992-019-0451-4 [doi]
LID - 10
AB  - BACKGROUND: The increasing prevalence of type 2 diabetes mellitus (T2DM) can have 
      a substantial impact in low- and middle-income countries (LMICs). Community-based 
      programs addressing diet, physical activity, and health behaviors have shown 
      significant benefits on the prevention and management of T2DM, mainly in 
      high-income countries. However, their effects on preventing T2DM in the at-risk 
      population of LMICs have not been thoroughly evaluated. METHODS: The Cochrane 
      Library (CENTRAL), MEDLINE, EMBASE and two clinical trial registries were 
      searched to identify eligible studies. We applied a 10 years limit (from 01 Jan 
      2008 to 06 Mar 2018) on English language literature. We included randomized 
      controlled trials (RCTs) with programs focused on lifestyle changes such as 
      weight loss and/or physical activity increase, without pharmacological 
      treatments, which aimed to alter incidence of diabetes or one of the T2DM risk 
      factors, of at least 6 months duration based on follow-up, conducted in LMICs. 
      RESULTS: Six RCTs randomizing 2574 people were included. The risk of developing 
      diabetes in the intervention groups reduced more than 40%, RR (0.57 [0.30, 
      1.06]), for 1921 participants (moderate quality evidence), though it was not 
      statistically significant. Significant differences were observed in weight, body 
      mass index, and waist circumference change in favor of community-based programs 
      from baseline, (MD [95% CI]; - 2.30 [- 3.40, - 1.19], p < 0.01, I2 = 87%), (MD 
      [95% CI]; - 1.27 [- 2.10, - 0.44], p < 0.01, I2 = 96%), and (MD [95% CI]; - 1.66 
      [- 3.17, - 0.15], p = 0.03, I2 = 95%), respectively. The pooled effect showed a 
      significant reduction in fasting blood glucose and HbA1C measurements in favor of 
      the intervention (MD [95% CI]; - 4.94 [- 8.33, - 1.55], p < 0.01, I2 = 62%), (MD 
      [95% CI]; - 1.17 [- 1.51, - 0.82], p < 0.01, I2 = 46%), respectively. No 
      significant difference was observed in 2-h blood glucose values, systolic or 
      diastolic blood pressure change between the two groups. CONCLUSION: Based on 
      available literature, evidence suggests that community-based interventions may 
      reduce the incidence rate of T2DM and may positively affect anthropometric 
      indices and HbA1C. Due to the heterogeneity observed between trials we recommend 
      more well-designed RCTs with longer follow-up durations be executed, to confirm 
      whether community-based interventions lead to reduced T2DM events in the at-risk 
      population of LMIC settings.
FAU - Shirinzadeh, Maryam
AU  - Shirinzadeh M
AD  - Department of Health Research Methodology, McMaster University, 1280 Main St W, 
      Hamilton, Ontario, L8S 4L8, Canada. shirinzm@mcmaster.ca.
FAU - Afshin-Pour, Babak
AU  - Afshin-Pour B
AD  - Biosymetric Inc, 180 John St, Toronto, Ontario, M5T 1X5, Canada.
FAU - Angeles, Ricardo
AU  - Angeles R
AD  - Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, 
      Ontario, L8S 4L8, Canada.
FAU - Gaber, Jessica
AU  - Gaber J
AD  - Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, 
      Ontario, L8S 4L8, Canada.
FAU - Agarwal, Gina
AU  - Agarwal G
AD  - Department of Family Medicine, and Department of Health Research Methods, 
      Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 
      4L8, Canada.
LA  - eng
GR  - CIHR/Canada
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20190201
PL  - England
TA  - Global Health
JT  - Globalization and health
JID - 101245734
SB  - IM
MH  - *Community Health Services
MH  - *Developing Countries
MH  - Diabetes Mellitus, Type 2/*prevention & control
MH  - Humans
MH  - Program Evaluation
MH  - Randomized Controlled Trials as Topic
PMC - PMC6359819
OTO - NOTNLM
OT  - Community-based program
OT  - Diabetes
OT  - HbA1C
OT  - Incidence rate
OT  - Low and middle income countries
OT  - Meta-analysis
OT  - Systematic review
COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: Not applicable. CONSENT FOR 
      PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they 
      have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral 
      with regard to jurisdictional claims in published maps and institutional 
      affiliations.
EDAT- 2019/02/03 06:00
MHDA- 2019/02/27 06:00
PMCR- 2019/02/01
CRDT- 2019/02/03 06:00
PHST- 2018/10/29 00:00 [received]
PHST- 2019/01/10 00:00 [accepted]
PHST- 2019/02/03 06:00 [entrez]
PHST- 2019/02/03 06:00 [pubmed]
PHST- 2019/02/27 06:00 [medline]
PHST- 2019/02/01 00:00 [pmc-release]
AID - 10.1186/s12992-019-0451-4 [pii]
AID - 451 [pii]
AID - 10.1186/s12992-019-0451-4 [doi]
PST - epublish
SO  - Global Health. 2019 Feb 1;15(1):10. doi: 10.1186/s12992-019-0451-4.