Integrated Management of Type 2 Diabetes and Gestational Diabetes in the Context of Multi-Morbidity in Africa: A Systematic Review
Introduction: Many adults diagnosed with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) also have other known or unknown comorbid conditions. The rising prevalence of GDM and T2DM within a broader context of multimorbidity can best be addressed through an integrated manageme...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Ubiquity Press
2022-09-01
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| Series: | International Journal of Integrated Care |
| Subjects: | |
| Online Access: | https://www.ijic.org/articles/5608 |
| _version_ | 1817984320331055104 |
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| author | Jean Claude Mutabazi Mahmoud Werfalli Angeli Rawat Ezekiel Musa Tawanda Chivese Shane Norris Katherine Murphy Helen Trottier Naomi Levitt Christina Zarowsky |
| author_facet | Jean Claude Mutabazi Mahmoud Werfalli Angeli Rawat Ezekiel Musa Tawanda Chivese Shane Norris Katherine Murphy Helen Trottier Naomi Levitt Christina Zarowsky |
| author_sort | Jean Claude Mutabazi |
| collection | DOAJ |
| description | Introduction: Many adults diagnosed with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) also have other known or unknown comorbid conditions. The rising prevalence of GDM and T2DM within a broader context of multimorbidity can best be addressed through an integrated management response, instead of stand-alone programs targeting specific infectious and/or chronic diseases. Aim: To describe GDM and T2DM screening, care and cost-effectiveness outcomes in the context of multimorbidity through integrated interventions in Africa. Methods: A systematic review of all published studies was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk Of Bias in Non-randomised Studies of Interventions (ROBINS-I) was used to assess risk of bias. Data synthesis was conducted using narrative synthesis of included studies. Results: A total of 9 out of 13 included studies reported integrated diabetes mellitus (DM) screening, 7 included integrated care and 9 studies addressed cases of newly detected DM who were asymptomatic in pre-diabetes stage. Only 1 study clearly analysed cost-effectiveness in home-based care; another 5 did not evaluate cost-effectiveness but discussed potential cost benefits of an integrated approach to DM screening and care. Compared to partial integration, only 2 fully integrated interventions yielded tangible results regarding DM screening, care and early detection of cases despite many that reported barriers to its sustainability. Conclusion: Though few, integrated interventions for screening and/or care of DM in the context of multimorbidity within available resources in health systems throughout Africa exist and suggest that this approach is possible and could improve health outcomes. |
| first_indexed | 2024-04-13T23:43:11Z |
| format | Article |
| id | doaj.art-15ddb756b3d846c9969d6cbb775ec348 |
| institution | Directory Open Access Journal |
| issn | 1568-4156 |
| language | English |
| last_indexed | 2024-04-13T23:43:11Z |
| publishDate | 2022-09-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | International Journal of Integrated Care |
| spelling | doaj.art-15ddb756b3d846c9969d6cbb775ec3482022-12-22T02:24:25ZengUbiquity PressInternational Journal of Integrated Care1568-41562022-09-0122310.5334/ijic.56086014Integrated Management of Type 2 Diabetes and Gestational Diabetes in the Context of Multi-Morbidity in Africa: A Systematic ReviewJean Claude Mutabazi0Mahmoud Werfalli1Angeli Rawat2Ezekiel Musa3Tawanda Chivese4Shane Norris5Katherine Murphy6Helen Trottier7Naomi Levitt8Christina Zarowsky9Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montreal, QC, H3N 1X7; Centre de Recherche en Santé Publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal; Centre de Recherche du Centre Hospitalier Universitaire Sainte Justine, Montréal, H3T 1C5, QCDepartment of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, Western CapeThe School of Population and Public Health, University of British Colombia, VancouverDepartment of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, Western CapeDepartment of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, Western Cape; Integrated Intervention for DIAbetes risks after GestatiOnal diabetes (IINDIAGO), Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, Western CapeIntegrated Intervention for DIAbetes risks after GestatiOnal diabetes (IINDIAGO), Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, Western Cape; University of Witwatersrand, Paediatrics and Child Health Johannesburg, GautengDepartment of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, Western Cape; Integrated Intervention for DIAbetes risks after GestatiOnal diabetes (IINDIAGO), Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, Western CapeDépartement de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montreal, QC, H3N 1X7; Centre de Recherche du Centre Hospitalier Universitaire Sainte Justine, Montréal, H3T 1C5, QCDepartment of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, Western Cape; Integrated Intervention for DIAbetes risks after GestatiOnal diabetes (IINDIAGO), Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, Western CapeDépartement de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montreal, QC, H3N 1X7; Centre de Recherche en Santé Publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, CA; School of Public Health, University of the Western Cape, Robert Sobukwe Rd, Bellville 7535Introduction: Many adults diagnosed with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) also have other known or unknown comorbid conditions. The rising prevalence of GDM and T2DM within a broader context of multimorbidity can best be addressed through an integrated management response, instead of stand-alone programs targeting specific infectious and/or chronic diseases. Aim: To describe GDM and T2DM screening, care and cost-effectiveness outcomes in the context of multimorbidity through integrated interventions in Africa. Methods: A systematic review of all published studies was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk Of Bias in Non-randomised Studies of Interventions (ROBINS-I) was used to assess risk of bias. Data synthesis was conducted using narrative synthesis of included studies. Results: A total of 9 out of 13 included studies reported integrated diabetes mellitus (DM) screening, 7 included integrated care and 9 studies addressed cases of newly detected DM who were asymptomatic in pre-diabetes stage. Only 1 study clearly analysed cost-effectiveness in home-based care; another 5 did not evaluate cost-effectiveness but discussed potential cost benefits of an integrated approach to DM screening and care. Compared to partial integration, only 2 fully integrated interventions yielded tangible results regarding DM screening, care and early detection of cases despite many that reported barriers to its sustainability. Conclusion: Though few, integrated interventions for screening and/or care of DM in the context of multimorbidity within available resources in health systems throughout Africa exist and suggest that this approach is possible and could improve health outcomes.https://www.ijic.org/articles/5608integrated carediabetes mellitustype 2 diabetesgestational diabetesmultimorbiditysyndemichealth systems |
| spellingShingle | Jean Claude Mutabazi Mahmoud Werfalli Angeli Rawat Ezekiel Musa Tawanda Chivese Shane Norris Katherine Murphy Helen Trottier Naomi Levitt Christina Zarowsky Integrated Management of Type 2 Diabetes and Gestational Diabetes in the Context of Multi-Morbidity in Africa: A Systematic Review International Journal of Integrated Care integrated care diabetes mellitus type 2 diabetes gestational diabetes multimorbidity syndemic health systems |
| title | Integrated Management of Type 2 Diabetes and Gestational Diabetes in the Context of Multi-Morbidity in Africa: A Systematic Review |
| title_full | Integrated Management of Type 2 Diabetes and Gestational Diabetes in the Context of Multi-Morbidity in Africa: A Systematic Review |
| title_fullStr | Integrated Management of Type 2 Diabetes and Gestational Diabetes in the Context of Multi-Morbidity in Africa: A Systematic Review |
| title_full_unstemmed | Integrated Management of Type 2 Diabetes and Gestational Diabetes in the Context of Multi-Morbidity in Africa: A Systematic Review |
| title_short | Integrated Management of Type 2 Diabetes and Gestational Diabetes in the Context of Multi-Morbidity in Africa: A Systematic Review |
| title_sort | integrated management of type 2 diabetes and gestational diabetes in the context of multi morbidity in africa a systematic review |
| topic | integrated care diabetes mellitus type 2 diabetes gestational diabetes multimorbidity syndemic health systems |
| url | https://www.ijic.org/articles/5608 |
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