Effectiveness of Interventions to Improve Glycemic Control in US Asian and Pacific Islander Populations With Type 2 Diabetes: Systematic Review and Meta-Analysis

Background: Asian American and Pacific Islander populations are disproportionately affected by diabetes. Objective: The purpose of this study was to assess the efficacy of nonpharmacologic interventions in reducing hemoglobin A1c (HbA1c) levels among Asian American or Pacific Islander individuals with type 2 diabetes. Methods: A systematic review was conducted using the PubMed, Scopus, PsycInfo, and CINAHL databases, covering studies published from 1985 to 2019. Eligible studies were randomized controlled trials that evaluated nonpharmacologic interventions in outpatient settings for adults with type 2 diabetes in the United States, with at least 50% Asian American or Pacific Islander participants. Data extraction and risk of bias assessment were independently performed by 2 reviewers for each trial. 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 1835 articles were screened, with 9 randomized controlled trials meeting the inclusion criteria, comprising 1492 participants, with a median follow-up duration of 6 (IQR 3-12) 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 of the 9 trials demonstrated a significant 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, 1 study had some concerns, and 1 study was assessed as high risk. The overall strength of evidence was high. Conclusions: Nonpharmacologic interventions substantively reduced HbA1c levels in Asian American or Pacific Islander individuals with type 2 diabetes, particularly when culturally and linguistically tailored.