Integrated Management of Type 2 Diabetes and Gestational Diabetes in the Context of Multi-Morbidity in Africa: A Systematic Review

Jean Claude Mutabazi; Mahmoud Werfalli; Angeli Rawat; Ezekiel Musa; Tawanda Chivese; Shane Norris; Katherine Murphy; Helen Trottier; Naomi Levitt; Christina Zarowsky

doi:10.5334/ijic.5608

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

Volume 22 (2022): Issue 3

By: Jean Claude Mutabazi , Mahmoud Werfalli , Angeli Rawat , Ezekiel Musa , Tawanda Chivese , Shane Norris , Katherine Murphy, Helen Trottier , Naomi Levitt and Christina Zarowsky

Open Access

|Sep 2022

Abstract

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.

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Articles in this issue

DOI: https://doi.org/10.5334/ijic.5608 | Journal eISSN: 1568-4156

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Language: English

Submitted on: Aug 31, 2020

Accepted on: Aug 30, 2022

Published on: Sep 21, 2022

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

integrated care,

diabetes mellitus,

type 2 diabetes,

gestational diabetes,

multimorbidity,

syndemic,

health systems

© 2022 Jean Claude Mutabazi, Mahmoud Werfalli, Angeli Rawat, Ezekiel Musa, Tawanda Chivese, Shane Norris, Katherine Murphy, Helen Trottier, Naomi Levitt, Christina Zarowsky, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 22 (2022): Issue 3