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Systematic Review of Primary Healthcare Interventions to Improve Diabetes Outcomes in Minority Ethnic Groups

Saxena, Sonia MBBS, MD; Misra, Tania MBBS, MD; Car, Josip MD, PhD; Netuveli, Gopalakrishnan PhD; Smith, Richard MBBS; Majeed, Azeem MBBCh, MD

Journal of Ambulatory Care Management: July-September 2007 - Volume 30 - Issue 3 - p 218–230
doi: 10.1097/01.JAC.0000278982.65063.5c

Objectives To systematically review the effectiveness of primary care interventions on glycaemic control and cardiovascular risk factors in minority ethnic groups with diabetes.

Research design and methods We searched electronic databases, the Cochrane Library, and research registers to December 2006, using multiple search terms related to ethnicity and diabetes. We examined bibliographies of retrieved articles and corresponded with authors. We included randomized controlled trials, controlled clinical trials, and cohort studies. Two reviewers independently assessed study eligibility and quality.

Results Nine studies including 2565 patients met our inclusion criteria. Two main models of care were identified: (1) case management, with specialist diabetes nurses and community health workers and (2) the use of the services of link workers from minority ethnic groups to guide people with diabetes. Heterogeneity of the studies prevented us from carrying out a meta-analysis. Case management improved glycaemic control (reduction in HbA1c range −0.5% to −1.75%). Small but statistically significant reductions in other cardiovascular risk factors were reported with both models.

Conclusions In minority ethnic groups with diabetes, case management improves glycaemic control and cardiovascular risk factors and link workers improve cardiovascular risk factor control. However, their relative effectiveness, cost, and sustainability of changes over time warrant further evaluation.

From the Department of Primary Care & Social Medicine, Imperial College London, London, United Kingdom.

Corresponding author: Sonia Saxena, MBBS, MD, Department of Primary Care & Social Medicine, Imperial College Faculty of Medicine, Reynolds Bldg, St Dunstan's Rd, London W6 8RP, United Kingdom (e-mail:

This article came from a report commissioned by United Health Europe. Dr Saxena is supported by a national fellowship award from the UK Department of Health. R.S. had a role in the design of the study but not its conduct. R.S. was involved on the interpretation of the data and reviewed and approved the manuscript. No other member of the sponsor had any role in the study. We thank Dr Shamini Gnani for her advice. R.S., A.M., and S.S. conceived the idea for the study, which was developed and refined by all authors. S.S. and T.M. carried out the searches and S.S., T.M., and J.C. reviewed the studies. All authors contributed to the writing of the paper and commented on the final draft.

© 2007 Lippincott Williams & Wilkins, Inc.