Community Health Worker Interventions to Improve Glycemic Control in People with Diabetes: A Systematic Review and Meta-Analysis

Journal of General Internal Medicine
Walter PalmasJosé A Luchsinger

Abstract

We set out to review the efficacy of Community Health Worker (CHW) interventions to improve glycemia in people with diabetes. Data sources included the Cochrane Central Register of Controlled Trials, Medline, clinicaltrials.gov, Google Scholar, and reference lists of previous publications. We reviewed randomized controlled trials (RCTs) that assessed the efficacy of CHW interventions, as compared to usual care, to lower hemoglobin A1c (A1c). Two investigators independently reviewed the RCTs and assessed their quality. Only RCTs with a follow-up of at least 12 months were meta-analyzed. A random effects model was used to estimate, from unadjusted within-group mean reductions, the standardized mean difference (SMD) in A1c achieved by the CHW intervention, beyond usual care. Thirteen RCTs were included in the narrative review, and nine of them, which had at least 12 months of follow-up, were included in the meta-analysis. Publication bias could not be ruled-out due to the small number of trials. Outcome heterogeneity was moderate (I(2)= 37%). The SMD in A1c (95% confidence interval) was 0.21 (0.11-0.32). Meta-regression showed an association between higher baseline A1c and a larger effect size. CHW interventions showed a modest re...Continue Reading

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Citations

Oct 16, 2015·Current Diabetes Reports·Mariana LazoRafael Perez-Escamilla
Apr 12, 2015·Journal of General Internal Medicine·Maria E Garcia, Richard W Grant
May 20, 2016·Diabetic Medicine : a Journal of the British Diabetic Association·J S RuddockN J Davis
Jun 21, 2016·American Journal of Preventive Medicine·Lewis L HsuMolly Martin
Mar 24, 2017·Diabetes & Vascular Disease Research : Official Journal of the International Society of Diabetes and Vascular Disease·Judith AponteCyril Ikechi
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