JMIR Publications

ABSTRACT

Background:

Hypertension and diabetes are global health challenges requiring effective management to mitigate their considerable burden. The key to successful management of hypertension and diabetes requires the completion of a sequence of stages, collectively termed as care cascade.

Objective:

This scoping review aimed to describe the characteristics of studies on hypertension and diabetes care cascade and identify potential interventions as well as factors that impact each stage of the care cascade.

Methods:

The method of this scoping review is guided by Arksey and O’Malley’s framework. We systematically searched Medline, Embase and Web of Science using terms pertinent to hypertension, diabetes and specific stages of the care cascade. We reviewed articles published after 2011 and included all studies that described the completion of at least one stage of the care cascade of hypertension or/and diabetes. We synthesised studies to identify targeted cascade stages, facilitators and barriers to retention, and interventions to mitigate the attrition and knowledge gaps.

Results:

A total of 128 studies were included, with 42% conducted in high-income countries. Of these, 75% were observational in design. Cascade stages documented in the literature were awareness, screening, diagnosis, linked to care, treatment, adherence to medication and control. Most studies described the stage from treatment initiation to disease control as completion. A wide spectrum of interventions aimed at enhancing hypertension and diabetes care cascade were identified. The analysis unveiled a multitude of individual-level and system-level factors influencing the successful completion of cascade sequence in both high-income and low and middle-income settings.

Conclusions:

This review offers a comprehensive understanding of hypertension and diabetes management, emphasizing the pivotal factors that impact each stage of care. Future research should focus on upstream cascade stages and context-specific interventions to optimise patient retention and care outcomes.