Health education for ethnic minority groups with Type 2 diabetes

Creamer J, Attridge M, Ramsden M, et al. Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: An updated Cochrane Review of randomized controlled trials Diabet Med. 2016;33:169-183.

Review question

Does culturally appropriate diabetes health education improve health outcomes compared to conventional education for ethnic minority groups with Type 2 diabetes?

Background

Ethnic minority groups living in upper-middle and high income countries have a higher prevalence of Type 2 diabetes than the general population. While health education programs have been shown to be effective in the treatment of Type 2 diabetes in the general population, they are much less successful in people from ethnic minority groups. The lack of effectiveness is attributed to a failure to account for cultural beliefs and values and language requirements. Few studies have examined the long-term and cost-effectiveness of culturally appropriate diabetes health education programs.

How the review was done

The researchers updated a previously published systematic review, adding 22 new randomized controlled trials to the 11 included in the original Cochrane Review). A meta-analysis was conducted on 28 of the trials.

The trials included 7453 participants. Ethnic minority groups included African Americans, Hispanic Americans, Native Americans, South Asians, Koreans, American Samoans, and Portuguese Canadians.

Key features of the studies were:

• The studies differed by duration (1 session to 24 months), study type (group versus individual versus combination), control group (‘usual care’, ‘minimal intervention’, culturally neutral education, or less resources), and length of follow-up (3 to 24 months).
• Diabetes health education programs were based either on recognized theoretical models or on previous experience with the ethnic minority group.
• Researchers measured changes in blood sugar control, quality of life, health behaviours and attitudes, diabetes knowledge, lipid levels (total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol), blood pressure (systolic and diastolic), and weight (body mass index).

What the researchers found

Culturally appropriate health education programs significantly improved blood sugar control among participants at 3 and 6 and 12 months of follow-up, although effects had begun to diminish by 12 months. Diabetes knowledge was also significantly improved at 3, 6, and 12 months of follow-up, and there was a reduction in triglycerides at 3 months. The effects on several outcome measures, including total cholesterol, low-density lipoprotein, high-density lipoprotein, blood pressure, weight, health-related quality of life, self-efficacy, and empowerment were not significant. There was insufficient data collected on diabetic complications, mortality, and health economics.

Conclusion

Culturally appropriate health education programs improve blood sugar control and knowledge about diabetes over usual care in ethnic minority groups. More research is needed surrounding the long-term and cost-effectiveness of such programs.