Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review

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Abstract

Background

Type 2 Diabetes Mellitus (T2DM) is reported to affect one in 11 adults worldwide, with over 80% of T2DM patients residing in low-to-middle-income countries. Health systems play an integral role in responding to this increasing global prevalence, and are key to ensuring effective diabetes management. We conducted a systematic review to examine the health system-level factors influencing T2DM awareness, treatment, adherence, and control.

Methods and findings

A protocol for this study was published on the PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016048185). Studies included in this review reported the effects of health systems factors, interventions, policies, or programmes on T2DM control, awareness, treatment, and adherence. The following databases were searched on 22 February 2017: Medline, Embase, Global health, LILACS, Africa-Wide, IMSEAR, IMEMR, and WPRIM. There were no restrictions on date, language, or study designs. Two reviewers independently screened studies for eligibility, extracted the data, and screened for risk of bias. Thereafter, we performed a narrative synthesis. A meta-analysis was not conducted due to methodological heterogeneity across different aspects of included studies. 93 studies were included for qualitative synthesis; 7 were conducted in LMICs. Through this review, we found two key health system barriers to effective T2DM care and management: financial constraints faced by the patient and limited access to health services and medication. We also found three health system factors that facilitate effective T2DM care and management: the use of innovative care models, increased pharmacist involvement in care delivery, and education programmes led by healthcare professionals.

Conclusions

This review points to the importance of reducing, or possibly eliminating, out-of-pocket costs for diabetes medication and self-monitoring supplies. It also points to the potential of adopting more innovative and integrated models of care, and the value of task-sharing of care with pharmacists. More studies which identify the effect of health system arrangements on various outcomes, particularly awareness, are needed.

Related collections

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Kun-Ho Yoon, Jin-Hee Lee, Ji-Won Kim … (2006)

The proportions of people with type 2 diabetes and obesity have increased throughout Asia, and the rate of increase shows no sign of slowing. People in Asia tend to develop diabetes with a lesser degree of obesity at younger ages, suffer longer with complications of diabetes, and die sooner than people in other regions. Childhood obesity has increased substantially and the prevalence of type 2 diabetes has now reached epidemic levels in Asia. The health consequences of this epidemic threaten to overwhelm health-care systems in the region. Urgent action is needed, and advocacy for lifestyle changes is the first step. Countries should review and implement interventions, and take a comprehensive and integrated public-health approach. At the level of primary prevention, such programmes can be linked to other non-communicable disease prevention programmes that target lifestyle-related issues. The cost of inaction is clear and unacceptable.

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Kiran Patel, Tim Evans, Sania Nishtar … (2010)

National health systems need strengthening if they are to meet the growing challenge of chronic diseases in low-income and middle-income countries. By application of an accepted health-systems framework to the evidence, we report that the factors that limit countries' capacity to implement proven strategies for chronic diseases relate to the way in which health systems are designed and function. Substantial constraints are apparent across each of the six key health-systems components of health financing, governance, health workforce, health information, medical products and technologies, and health-service delivery. These constraints have become more evident as development partners have accelerated efforts to respond to HIV, tuberculosis, malaria, and vaccine-preventable diseases. A new global agenda for health-systems strengthening is arising from the urgent need to scale up and sustain these priority interventions. Most chronic diseases are neglected in this dialogue about health systems, despite the fact that non-communicable diseases (most of which are chronic) will account for 69% of all global deaths by 2030 with 80% of these deaths in low-income and middle-income countries. At the same time, advocates for action against chronic diseases are not paying enough attention to health systems as part of an effective response. Efforts to scale up interventions for management of common chronic diseases in these countries tend to focus on one disease and its causes, and are often fragmented and vertical. Evidence is emerging that chronic disease interventions could contribute to strengthening the capacity of health systems to deliver a comprehensive range of services-provided that such investments are planned to include these broad objectives. Because effective chronic disease programmes are highly dependent on well-functioning national health systems, chronic diseases should be a litmus test for health-systems strengthening. Copyright © 2010 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Suan Ee Ong:

ORCID: http://orcid.org/0000-0001-7365-9015

Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

Joel Jun Kai Koh: Role: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

Sue-Anne Ee Shiow Toh: Role: Formal analysisRole: Writing – review & editing

Kee Seng Chia: Role: Writing – review & editing

Dina Balabanova: Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – review & editing

Martin McKee:

ORCID: http://orcid.org/0000-0002-0121-9683

Role: ConceptualizationRole: Formal analysisRole: Writing – review & editing

Pablo Perel: Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – review & editing

Helena Legido-Quigley: Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Cesario Bianchi: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 29 March 2018

Publication date Collection: 2018

Volume: 13

Issue: 3

Electronic Location Identifier: e0195086

Affiliations

[1 ] Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

[2 ] Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

[3 ] Division of Endocrinology, Department of Medicine, National University Health System, Singapore, Singapore

[4 ] London School of Hygiene and Tropical Medicine, London, United Kingdom

[5 ] World Heart Federation, Geneva, Switzerland

Universidade de Mogi das Cruzes, BRAZIL

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: suaneeong@ 123456u.nus.edu

Author information

Suan Ee Ong http://orcid.org/0000-0001-7365-9015

Martin McKee http://orcid.org/0000-0002-0121-9683

Article

Publisher ID: PONE-D-17-39777

DOI: 10.1371/journal.pone.0195086

PMC ID: 5875848

PubMed ID: 29596495

SO-VID: 889bad23-4f54-4937-9a35-04e8f8efad40

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 9 November 2017

Date accepted : 18 March 2018

Page count

Figures: 3, Tables: 6, Pages: 42

Funding

This research was supported by funding from an NUS Saw Swee Hock School of Public Health War on Diabetes Seed Fund Grant (WBS R-608-000-155-223) to JJKK and the National University Health System (NUHS) Singapore Population Health Improvement Centre (SPHERiC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability All relevant data are within the paper and its Supporting Information files.