Keywords

culturally tailored intervention, diabetes mellitus, ethnic minority, meta-analysis, type 2 diabetes

Authors

1. Nam, Soohyun PhD, RN, NP
2. Janson, Susan L. DNSc, RN, FAAN
3. Stotts, Nancy A. EdD, RN, FAAN
4. Chesla, Catherine DNSc, RN, FAAN
5. Kroon, Lisa PharmD, CDE

Abstract

Background: Diabetes is a major cause of cardiovascular morbidity and mortality. Ethnic minorities experience a disproportionate burden of diabetes; however, few studies have critically analyzed the effectiveness of a culturally tailored diabetes intervention for these minorities.

Objective: The aim of this study was to evaluate the effectiveness of a culturally tailored diabetes educational intervention (CTDEI) on glycemic control in ethnic minorities with type 2 diabetes.

Method: We searched databases within PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), PsycINFO, and ProQuest for randomized controlled trials (RCTs). We performed a meta-analysis for the effect of diabetes educational intervention on glycemic control using glycosylated hemoglobin (HbA_1c) value in ethnic minority groups with type 2 diabetes. We calculated the effect size (ES) with HbA_1c change from baseline to follow-up between control and treatment groups.

Results: The 12 studies yielded 1495 participants with a mean age of 63.6 years and a mean of 68% female participants. Most studies (84%) used either group education sessions or a combination of group sessions and individual patient counseling. The duration of interventions ranged from 1 session to 12 months. The pooled ES of glycemic control in RCTs with CTDEI was -0.29 (95% confidence interval, -0.46 to -0.13) at last follow-up, indicating that ethnic minorities benefit more from CTDEI when compared with the usual care. The effect of intervention was greatest and significant when HbA_1c level was measured at 6 months (ES, -0.41; 95% confidence interval, -0.61 to -0.21). The ES also differed by each participant's baseline HbA_1c level, with lower baseline levels associated with higher ESs.

Conclusions: Based on this meta-analysis, CTDEI is effective for improving glycemic control among ethnic minorities. The magnitude of effect varies based on the settings of intervention, baseline HbA_1c level, and time of HbA_1c measurement. More rigorous RCTs that examine tailored diabetes education, ethnically matched educators, and more diverse ethnic minority groups are needed to reduce health disparities in diabetes care.