Integrated management of type 2 diabetes and gestational diabetes in the context of multi-morbidity in Africa: a systematic review
Integrated management of type 2 diabetes and gestational diabetes in the context of multi-morbidity in Africa: a systematic review
Introduction: Many adults diagnosed with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) also have other known or unknown comorbid conditions. The rising prevalence of GDM and T2DM within a broader context of multimorbidity can best be addressed through an integrated management response, instead of stand-alone programs targeting specific infectious and/or chronic diseases.
Aim: To describe GDM and T2DM screening, care and cost-effectiveness outcomes in the context of multimorbidity through integrated interventions in Africa.
Methods: A systematic review of all published studies was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk Of Bias in Non-randomised Studies of Interventions (ROBINS-I) was used to assess risk of bias. Data synthesis was conducted using narrative synthesis of included studies.
Results: A total of 9 out of 13 included studies reported integrated diabetes mellitus (DM) screening, 7 included integrated care and 9 studies addressed cases of newly detected DM who were asymptomatic in pre-diabetes stage. Only 1 study clearly analysed cost-effectiveness in home-based care; another 5 did not evaluate cost-effectiveness but discussed potential cost benefits of an integrated approach to DM screening and care. Compared to partial integration, only 2 fully integrated interventions yielded tangible results regarding DM screening, care and early detection of cases despite many that reported barriers to its sustainability.
Conclusion: Though few, integrated interventions for screening and/or care of DM in the context of multimorbidity within available resources in health systems throughout Africa exist and suggest that this approach is possible and could improve health outcomes.
integrated care, diabetes mellitus, type 2 diabetes, gestational diabetes, multimorbidity, syndemic, health systems
Mutabazi, Jean Claude
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Werfalli, Mahmoud
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Rawat, Angeli
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Musa, Ezekiel
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Chivese, Tawanda
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Norris, Shane
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Murphy, Katherine
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Trottier, Helen
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Levitt, Naomi
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Zarowsky, Christina
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21 September 2022
Mutabazi, Jean Claude
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Werfalli, Mahmoud
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Rawat, Angeli
ebed65ad-201c-4aa5-a82b-d11953e62bec
Musa, Ezekiel
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Chivese, Tawanda
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Norris, Shane
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Murphy, Katherine
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Trottier, Helen
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Levitt, Naomi
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Zarowsky, Christina
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Mutabazi, Jean Claude, Werfalli, Mahmoud, Rawat, Angeli, Musa, Ezekiel, Chivese, Tawanda, Norris, Shane, Murphy, Katherine, Trottier, Helen, Levitt, Naomi and Zarowsky, Christina
(2022)
Integrated management of type 2 diabetes and gestational diabetes in the context of multi-morbidity in Africa: a systematic review.
International Journal of Integrated Care, 22, [21].
(doi:10.5334/ijic.5608).
Abstract
Introduction: Many adults diagnosed with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) also have other known or unknown comorbid conditions. The rising prevalence of GDM and T2DM within a broader context of multimorbidity can best be addressed through an integrated management response, instead of stand-alone programs targeting specific infectious and/or chronic diseases.
Aim: To describe GDM and T2DM screening, care and cost-effectiveness outcomes in the context of multimorbidity through integrated interventions in Africa.
Methods: A systematic review of all published studies was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk Of Bias in Non-randomised Studies of Interventions (ROBINS-I) was used to assess risk of bias. Data synthesis was conducted using narrative synthesis of included studies.
Results: A total of 9 out of 13 included studies reported integrated diabetes mellitus (DM) screening, 7 included integrated care and 9 studies addressed cases of newly detected DM who were asymptomatic in pre-diabetes stage. Only 1 study clearly analysed cost-effectiveness in home-based care; another 5 did not evaluate cost-effectiveness but discussed potential cost benefits of an integrated approach to DM screening and care. Compared to partial integration, only 2 fully integrated interventions yielded tangible results regarding DM screening, care and early detection of cases despite many that reported barriers to its sustainability.
Conclusion: Though few, integrated interventions for screening and/or care of DM in the context of multimorbidity within available resources in health systems throughout Africa exist and suggest that this approach is possible and could improve health outcomes.
Text
5608-1-26626-1-10-20220921
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Submitted date: 31 August 2020
Accepted/In Press date: 30 August 2022
Published date: 21 September 2022
Keywords:
integrated care, diabetes mellitus, type 2 diabetes, gestational diabetes, multimorbidity, syndemic, health systems
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Local EPrints ID: 496673
URI: http://eprints.soton.ac.uk/id/eprint/496673
PURE UUID: 90aa4f24-4962-4edb-8b11-280df141dd04
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Date deposited: 07 Jan 2025 19:08
Last modified: 10 Jan 2025 03:05
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Contributors
Author:
Jean Claude Mutabazi
Author:
Mahmoud Werfalli
Author:
Angeli Rawat
Author:
Ezekiel Musa
Author:
Tawanda Chivese
Author:
Katherine Murphy
Author:
Helen Trottier
Author:
Naomi Levitt
Author:
Christina Zarowsky
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