Effects of Multilevel and Multidomain Interventions on Glycemic Control Among Black Persons with Type 2 Diabetes in the U.S.: A Systematic Review and Meta-Analysis

Background Type 2 diabetes (T2D) disproportionately affects Black individuals in the U.S., who have higher rates of complications and worse glycemic control. This systematic review and meta-analysis evaluated the effectiveness of non-pharmacological interventions on hemoglobin A1c (HbA1c) in this population. Methods We searched PubMed, Scopus, PsycInfo, and CINAHL for randomized controlled trials (RCTs) (1985–2019) enrolling ≥ 50% Black/African American adults with T2D or reporting race-specific HbA1c outcomes, with ≥ 3 months’ follow-up. Interventions were classified by levels and domains of influence using the National Institute on Minority Health and Health Disparities framework. Risk of bias and evidence certainty were assessed using Cochrane and GRADE. A random-effects meta-analysis estimated the weighted mean difference (WMD) in HbA1c. Results Forty-six RCTs (7,864 participants) met criteria. Interventions significantly reduced HbA1c (WMD − 0.38%; 95% CI − 0.51 to − 0.25; I²=50%, τ²=0.08). Multi-domain interventions achieved the largest reductions (− 0.43%; 95% CI − 0.60 to − 0.25; I²=53%, τ²=0.08). Risk of bias was low, and strength of evidence was high. No interventions addressed community/societal levels or the physical/built environment. Discussion Interventions significantly improved glycemic control among Black adults with T2D. These findings underscore the importance of comprehensive, culturally tailored approaches to diabetes self-management support. Further research is needed on structural interventions to address disparities.