JMIR Publications

ABSTRACT

Background:

Asian American and Pacific Islander populations are disproportionately affected by diabetes.

Objective:

The purpose of this study was to assess the efficacy of non-pharmacologic interventions in reducing glycated hemoglobin (HbA1c) among Asian American/Pacific Islander individuals with type 2 diabetes.

Methods:

A systematic review was conducted using PubMed, Scopus, PsycInfo, and CINAHL databases, covering studies published from 1985 to 2019. Eligible studies were randomized controlled trials that evaluated non-pharmacologic interventions in outpatient settings for adults with type 2 diabetes in the United States, with at least 50% Asian American/Pacific Islander participants. Data extraction and risk of bias assessment were independently performed by two reviewers. The Cochrane Collaboration risk of bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation approach were used to evaluate quality. Random-effects meta-analyses were conducted to estimate pooled effect sizes.

Results:

A total of 1,835 articles were screened, with nine randomized controlled trials meeting inclusion criteria, comprising 1,492 participants, with an average follow-up duration of 6.4 months. Interventions included diabetes self-management education, bilingual counseling, glucose or weight monitoring, motivational interviewing, and financial support, often tailored to the cultural context of the participants. Pooled analysis demonstrated an average HbA1c reduction of -0.39% (95% CI: -0.64% to -0.14%, I² = 65%). Seven studies were judged to have a low risk of bias, one had some concerns, and one was assessed as high risk. The overall strength of evidence was high.

Conclusions:

Non-pharmacologic interventions substantively reduced HbA1c levels in Asian American/Pacific Islander individuals with type 2 diabetes, particularly when culturally and linguistically tailored.