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Table 7 Glycaemic optimization interventions and glycaemic control in sub-Saharan Africa

From: Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis

First author name

Year

Study design

Study setting

Study population

Sample size

Measurement of glycemic control

Definition of glycemic control

Generic factor

Specific factors

Measure of association

Point estimate

Lower bound

Upper bound

Association with glycemic control

Mash [55]

2014

Pragmatic randomized controlled trial

South Africa

Type 2 diabetes

422

HbA1c

No threshold

Educational intervention

Effectiveness of group education

Mean difference

0.01

− 0.2

0.28

No significant difference between the intervention and control groups in reduction of HbA1c level by 1%

Thuita [81]

2020

Randomized controlled trail

Kenya

Type 2 diabetes; 20–79 years

153

HbA1C and FBG

Good control (HbA1c < 7%); poor control (HbA1c > 7%)

Effect of a nutrition education programme on the Metabolic syndrome in type 2 diabetes patients

Odds Ratio

2.04

0.84

4.92

No significant difference in the prevalence of high HbA1c between groups at six months post intervention (Nutrition education group versus Control)

2.08

0.85

5.09

No significant difference in the prevalence of high HbA1c between groups at six months post intervention (Nutrition education peer to peer support group (NEP) versus Control)

Gathu [41]

2018

Randomized controlled trial

Kenya

Sub-optimally controlled Type 2 diabetes; 18–65 years

140

HbA1c

No threshold

Diabetes self-management education

Mean difference

0.37

− 0.45

1.19

No significant difference in the primary outcome (HbA1c) between the two groups

Muchiri [63]

2016

Randomized controlled trial

South Africa

type 2 diabetes; 40–70 years

82

HbA1c

No threshold

Effect of a participant-customised nutrition education programme

Mean difference

− 0.64

− 0.19

1.15

No significant difference between the intervention and control groups for HbA1c at 6 months (p = 0·13)

− 0.63

− 0.26

1.5

No significant difference between the intervention and control groups for HbA1c at 12 months (p:0.16)

Hailu [43]

2018

Controlled before-and-after study

Ethiopia

Type 2 diabetes mellitus; > 30 years

220

FBS

No threshold

Nurse-led diabetes self-management education

Mean difference

27

17

37

Significant difference in the intervention group compared to the control group at 9 months

Fseha [40]

2017

Cross-sectional

Ethiopia

Type 2 diabetes; 22–60 years

200

FBS

Good (FBS 70–130 mg/dl), Poor (FBS > 130 mg/dl)

Self-management of diabetes

Home glucose monitoring

Odds Ratio

1.697

0.852

3.353

Home glucose monitoring was not associated with glycaemic control

Fseha [40]

2020

Cross-sectional

Malawi

Type 2 diabetes;  ≥ 25 years

428

HbA1c

Poor control (HbA1c clinically elevated ≥ 8%)

Additional blood glucose monitoring

ß coefficient

− 0.359

− 0.609

− 0.149

Additional blood glucose monitoring at private clinic/home/diabetes peer groups was not associated with glycaemic control

Mwavua [64]

2016

Cross-sectional

Kenya

Type 2 diabetes; ≥ 18 years

200

HbA1c

Good control (HbA1c < 7%); poor control (HbA1c ≥ 7%)

Monthly self-monitoring

Odds ratio

2.6

0.6

10.7

Monthly self-monitoring was not significantly associated with glycaemic control

Absence of self-monitoring

Odds Ratio

3.3

0.8

12.6

Absence of self-monitoring was not associated with glycaemic control

Maharaj [52]

2016

randomized controlled trial

Nigeria

Non-insulin dependent type 2 diabetes; 30–58 years

90

HbA1c

No threshold

Exercise programs

Effect of rebound exercise

Mean difference

0.904

0.832

0.985

Significant improvements at 9 weeks post-intervention in mean HbA1c in the exercise group

Yan [84]

2014

Randomized controlled trial

Mozambique

Type 2 diabetes; 40–70 years

41

HbA1c

No threshold

Effect of Aerobic Training

Mean difference

− 1.0

− 1.3

− 0.7

Significant reduction of plasma glucose at 120 min (Glu 120) following glucose load in the exercise group after training

Siddiqui [76]

2018

Quasi-experimental study

South Africa

Type 2 diabetes; 18–65 years

95

HbA1C

No threshold

Level of physical activity measured with a pedometer

Mean difference

− 1.0420

− 1.2225

− 0.86

Change in HbA1c over the three-month period was significant in the intervention group

Fayehun [38]

2018

Randomized trial

Nigeria

Type 2 diabetes; 33–64 years

46

HbA1c

No threshold

Physical activity with a 10,000 steps each day

Mean difference

− 0.74

− 1.32

− 0.02

Endline HbA1c was lower in the intervention group than in the control group

Ezema [37]

2014

Randomized trial

Nigeria

Type 2 diabetes; 40–55 years

54

FBS

No threshold

Aerobic exercise training (V02 max)

Pearson product moment correlation test

− 0.252

  

Significant effect of the exercise training program on FBS (p:0.001); 95% CI not provided

Mayet [57]

2012

Quasi-experimental study

South Africa

Type 2 diabetes

600

HbA1c

No threshold

Medical intervention

Insulin therapy initiation

Paired t-test

   

Mean HbA1c at insulin initiation was 10.29% (± 2.42), and 10.63% (± 1.93) after adjustment

of insulin dose (p-value > 0.05)

Rambiritch [71]

2014

A 12-week, prospective, single-center, open-label, dose-escalation study

South Africa

Poorly controlled type 2 diabetes requiring oral antidibetic medications; > 20 years

22

FBG

No threshold

Dose escalation of Glibenclamide

Analysis of variance

19.61

  

Significant decrease in percentage of glucose from dose zero to 2.5 mg (P ≤ 0.001); no significant decrease for the 2.5–5 mg, 5–10 mg, and 10–20 mg doses. 95% CI provided

Assah [24]

2015

Non-randomized controlled trial

Cameroon

Type 2 diabetes

192

HbA1c

No threshold

Multi level peer support

Effectiveness of a community-based multilevel peer support intervention

Mean difference

− 1.7

− 2.2

− 1.3

Significant reduction in HbA1c in the intervention group compared with controls

Mash [54]

2016

Quasi-experimental study

South Africa

Type 2 diabetes; > 18 years

600

HbA1c

No threshold

Laboratory testing

Introducing point-of-care (POC) testing for HbA1c

Mean difference

0.00

-1.5

1.5

No significant difference in

Mean difference in HbA1c result (%) at 18 months in the intervention group