A Complex Systematic Overview of Intervention Foci to Address Diabetes-Related Health Disparities

Objective:To conduct a complex systematic overview of systematic reviews to identify evidence for interventions to reduce or eliminate diabetes-related health disparities.

Methods:We devised definitions, a visual model, inclusion criteria, and abstraction forms. We searched MEDLINE, CINAHL, EMBASE, PsycInfo, Cochrane, and ERIC databases for publications (English only) from 1966-2009. We identified systematic reviews of diabetes-related interventions for racial/ethnic minorities, children, older adults, women, disabled, rural/urban populations, or addressing social determinants of health. We also searched reference lists for other reviews.

Results:The search yielded 4959 abstracts finding 173 systematic reviews of interest. Of these, 35 met our inclusion criteria. We abstracted 40 conclusions across 5 intervention foci: education; family; multi-level; provider, system-, and organizational-level; and psychological.

Conclusion:s covered 4 disparate groups: children-adolescents (n = 16 or 40%), racial-ethnic minorities (n= 14 or 36%), older adults (n = 6 or 16%), and low-income (n = 4 or 10%). Most reviews did not assess quality of evidence, or provide between-group comparisons. Heterogeneity of subjects, settings, intervention components and measurements made comparisons and definitive conclusions difficult. This often produced conclusions that varied widely within the same intervention focus. Regardless, we found many useful intervention foci which basically corresponded to interventions used to control diabetes and prevent its complications in the general U.S. population. Conclusion Conclusion A number of intervention foci exist for addressing diabetes-related health disparities whose limited evidence suggest some potential for success.