Community Health Worker Interventions to Improve Glycemic Control in People with Diabetes: A Systematic Review and Meta-Analysis

Walter Palmas, Dana March, Salima Darakjy, Sally E. Findley, Jeanne Teresi, Olveen Carrasquillo, José A. Luchsinger

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

OBJECTIVES: We set out to review the efficacy of Community Health Worker (CHW) interventions to improve glycemia in people with diabetes. METHODS: Data sources included the Cochrane Central Register of Controlled Trials, Medline, clinicaltrials.gov, Google Scholar, and reference lists of previous publications. We reviewed randomized controlled trials (RCTs) that assessed the efficacy of CHW interventions, as compared to usual care, to lower hemoglobin A1c (A1c). Two investigators independently reviewed the RCTs and assessed their quality. Only RCTs with a follow-up of at least 12 months were meta-analyzed. A random effects model was used to estimate, from unadjusted within-group mean reductions, the standardized mean difference (SMD) in A1c achieved by the CHW intervention, beyond usual care. RESULTS: Thirteen RCTs were included in the narrative review, and nine of them, which had at least 12 months of follow-up, were included in the meta-analysis. Publication bias could not be ruled-out due to the small number of trials. Outcome heterogeneity was moderate (I<sup>2</sup>= 37 %). The SMD in A1c (95 % confidence interval) was 0.21 (0.11-0.32). Meta-regression showed an association between higher baseline A1c and a larger effect size. CONCLUSIONS: CHW interventions showed a modest reduction in A1c compared to usual care. A1c reduction was larger in studies with higher mean baseline A1c. Caution is warranted, given the small number of studies.

Original languageEnglish (US)
Pages (from-to)1004-1012
Number of pages9
JournalJournal of General Internal Medicine
Volume30
Issue number7
DOIs
StatePublished - Mar 4 2015

Fingerprint

Meta-Analysis
Randomized Controlled Trials
Publication Bias
Information Storage and Retrieval
Hemoglobins
Research Personnel
Confidence Intervals

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Community Health Worker Interventions to Improve Glycemic Control in People with Diabetes : A Systematic Review and Meta-Analysis. / Palmas, Walter; March, Dana; Darakjy, Salima; Findley, Sally E.; Teresi, Jeanne; Carrasquillo, Olveen; Luchsinger, José A.

In: Journal of General Internal Medicine, Vol. 30, No. 7, 04.03.2015, p. 1004-1012.

Research output: Contribution to journalArticle

Palmas, Walter ; March, Dana ; Darakjy, Salima ; Findley, Sally E. ; Teresi, Jeanne ; Carrasquillo, Olveen ; Luchsinger, José A. / Community Health Worker Interventions to Improve Glycemic Control in People with Diabetes : A Systematic Review and Meta-Analysis. In: Journal of General Internal Medicine. 2015 ; Vol. 30, No. 7. pp. 1004-1012.
@article{09f01c04ac20425586d1433fcbedd008,
title = "Community Health Worker Interventions to Improve Glycemic Control in People with Diabetes: A Systematic Review and Meta-Analysis",
abstract = "OBJECTIVES: We set out to review the efficacy of Community Health Worker (CHW) interventions to improve glycemia in people with diabetes. METHODS: Data sources included the Cochrane Central Register of Controlled Trials, Medline, clinicaltrials.gov, Google Scholar, and reference lists of previous publications. We reviewed randomized controlled trials (RCTs) that assessed the efficacy of CHW interventions, as compared to usual care, to lower hemoglobin A1c (A1c). Two investigators independently reviewed the RCTs and assessed their quality. Only RCTs with a follow-up of at least 12 months were meta-analyzed. A random effects model was used to estimate, from unadjusted within-group mean reductions, the standardized mean difference (SMD) in A1c achieved by the CHW intervention, beyond usual care. RESULTS: Thirteen RCTs were included in the narrative review, and nine of them, which had at least 12 months of follow-up, were included in the meta-analysis. Publication bias could not be ruled-out due to the small number of trials. Outcome heterogeneity was moderate (I2= 37 {\%}). The SMD in A1c (95 {\%} confidence interval) was 0.21 (0.11-0.32). Meta-regression showed an association between higher baseline A1c and a larger effect size. CONCLUSIONS: CHW interventions showed a modest reduction in A1c compared to usual care. A1c reduction was larger in studies with higher mean baseline A1c. Caution is warranted, given the small number of studies.",
author = "Walter Palmas and Dana March and Salima Darakjy and Findley, {Sally E.} and Jeanne Teresi and Olveen Carrasquillo and Luchsinger, {Jos{\'e} A.}",
year = "2015",
month = "3",
day = "4",
doi = "10.1007/s11606-015-3247-0",
language = "English (US)",
volume = "30",
pages = "1004--1012",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "7",

}

TY - JOUR

T1 - Community Health Worker Interventions to Improve Glycemic Control in People with Diabetes

T2 - A Systematic Review and Meta-Analysis

AU - Palmas, Walter

AU - March, Dana

AU - Darakjy, Salima

AU - Findley, Sally E.

AU - Teresi, Jeanne

AU - Carrasquillo, Olveen

AU - Luchsinger, José A.

PY - 2015/3/4

Y1 - 2015/3/4

N2 - OBJECTIVES: We set out to review the efficacy of Community Health Worker (CHW) interventions to improve glycemia in people with diabetes. METHODS: Data sources included the Cochrane Central Register of Controlled Trials, Medline, clinicaltrials.gov, Google Scholar, and reference lists of previous publications. We reviewed randomized controlled trials (RCTs) that assessed the efficacy of CHW interventions, as compared to usual care, to lower hemoglobin A1c (A1c). Two investigators independently reviewed the RCTs and assessed their quality. Only RCTs with a follow-up of at least 12 months were meta-analyzed. A random effects model was used to estimate, from unadjusted within-group mean reductions, the standardized mean difference (SMD) in A1c achieved by the CHW intervention, beyond usual care. RESULTS: Thirteen RCTs were included in the narrative review, and nine of them, which had at least 12 months of follow-up, were included in the meta-analysis. Publication bias could not be ruled-out due to the small number of trials. Outcome heterogeneity was moderate (I2= 37 %). The SMD in A1c (95 % confidence interval) was 0.21 (0.11-0.32). Meta-regression showed an association between higher baseline A1c and a larger effect size. CONCLUSIONS: CHW interventions showed a modest reduction in A1c compared to usual care. A1c reduction was larger in studies with higher mean baseline A1c. Caution is warranted, given the small number of studies.

AB - OBJECTIVES: We set out to review the efficacy of Community Health Worker (CHW) interventions to improve glycemia in people with diabetes. METHODS: Data sources included the Cochrane Central Register of Controlled Trials, Medline, clinicaltrials.gov, Google Scholar, and reference lists of previous publications. We reviewed randomized controlled trials (RCTs) that assessed the efficacy of CHW interventions, as compared to usual care, to lower hemoglobin A1c (A1c). Two investigators independently reviewed the RCTs and assessed their quality. Only RCTs with a follow-up of at least 12 months were meta-analyzed. A random effects model was used to estimate, from unadjusted within-group mean reductions, the standardized mean difference (SMD) in A1c achieved by the CHW intervention, beyond usual care. RESULTS: Thirteen RCTs were included in the narrative review, and nine of them, which had at least 12 months of follow-up, were included in the meta-analysis. Publication bias could not be ruled-out due to the small number of trials. Outcome heterogeneity was moderate (I2= 37 %). The SMD in A1c (95 % confidence interval) was 0.21 (0.11-0.32). Meta-regression showed an association between higher baseline A1c and a larger effect size. CONCLUSIONS: CHW interventions showed a modest reduction in A1c compared to usual care. A1c reduction was larger in studies with higher mean baseline A1c. Caution is warranted, given the small number of studies.

UR - http://www.scopus.com/inward/record.url?scp=84931569921&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84931569921&partnerID=8YFLogxK

U2 - 10.1007/s11606-015-3247-0

DO - 10.1007/s11606-015-3247-0

M3 - Article

C2 - 25735938

AN - SCOPUS:84931569921

VL - 30

SP - 1004

EP - 1012

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 7

ER -