Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. May 25, 2016; 7(10): 209-229
Published online May 25, 2016. doi: 10.4239/wjd.v7.i10.209
Evidence based review of type 2 diabetes prevention and management in low and middle income countries
Aimee Afable, Nidhi Shree Karingula
Aimee Afable, Nidhi Shree Karingula, Department of Community Health Sciences, SUNY Downstate School of Public Health, New York, NY 11203, United States
Author contributions: Afable A conceptualized the design of the study and led writing of paper; under the guidance of Afable A and Karingula NS conducted the literature review and documented the process; Karingula NS also assisted in the synthesis, analysis and writing up of findings.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Aimee Afable, PhD, MPH, Assistant Professor, Department of Community Health Sciences, SUNY Downstate School of Public Health, 450 Clarkson Avenue, Box 43, Brooklyn, New York, NY 11203, United States. aimee.afable-munsuz@downstate.edu
Telephone: +1-718-2706397 Fax: +1-718-2215157
Received: December 11, 2014
Peer-review started: December 14, 2014
First decision: February 7, 2015
Revised: January 28, 2016
Accepted: March 7, 2016
Article in press: March 9, 2015
Published online: May 25, 2016
Processing time: 521 Days and 17 Hours
Abstract

AIM: To identify the newest approaches to type 2 diabetes (T2DM) prevention and control in the developing world context.

METHODS: We conducted a systematic review of published studies of diabetes prevention and control programs in low and middle-income countries, as defined by the World Bank. We searched PubMed using Medical Subject Headings terms. Studies needed to satisfy four criteria: (1) Must be experimental; (2) Must include patients with T2DM or focusing on prevention of T2DM; (3) Must have a lifestyle intervention component; (4) Must be written in English; and (5) Must have measurable outcomes related to diabetes.

RESULTS: A total of 66 studies from 20 developing countries were gathered with publication dates through September 2014. India contributed the largest number of trials (11/66). Of the total 66 studies reviewed, all but 3 studies reported evidence of favorable outcomes in the prevention and control of type 2 diabetes. The overwhelming majority of studies reported on diabetes management (56/66), and among these more than half were structured lifestyle education programs. The evidence suggests that lifestyle education led by allied health professionals (nurses, pharmacists) were as effective as those led by physicians or a team of clinicians. The remaining diabetes management interventions focused on diet or exercise, but the evidence to recommend one approach over another was weak.

CONCLUSION: Large experimental diabetes prevention/control studies of dietary and exercise interventions are lacking particularly those that consider quality rather than quantity of carbohydrates and alternative exercise.

Keywords: Diabetes prevention and control; Low-income countries; Middle-income countries; Intervention research; Systematic reviews

Core tip: We conducted a systematic review of published efficacy studies of diabetes prevention and control programs in low and middle-income countries. A total of 66 studies from 20 countries were gathered, based on our selection criteria. Of the 66 studies, all but 3 reported evidence of efficacy. Structured lifestyle education programs were the most common strategies. There was also a diverse range of dietary and exercise approaches. However, large experimental studies of their efficacy, particularly with regard to studies comparing alternative exercise to aerobic and quality of carbohydrates to quantity, are lacking.