Effectiveness of Diabetes Self-Management Education and Support on Glycemic Control and Diabetes-Related Outcomes in Africa: A Systematic Review and Meta-Analysis

AbstractIntroduction Diabetes prevalence in Africa continues to rise, presenting significant health and economic challenges. Effective management strategies, such as Diabetes Self-Management Education and Support (DSMES), are crucial for improving clinical outcomes. However, the impact of DSMES on glycemic control and related metabolic parameters in African populations remains unclear. Objective This study evaluates the effectiveness of DSMES interventions compared to standard diabetes care in Africa, with a focus on glycemic control and secondary metabolic outcomes. Methods A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. Comprehensive searches were performed in PubMed, Embase, CINAHL, Scopus, Web of Science, and PsycINFO, supplemented with regional sources such as Africa Journal Online (AJOL) and ProQuest. Randomized Controlled Trials (RCTs) published in English up to April 2024, involving adult participants with type 2 diabetes in Africa who received DSMES interventions, were included. The Cochrane Risk of Bias Tool 1 was used to assess study quality. Heterogeneity was evaluated using I² statistics, and random-effects models were applied for pooled estimates. Results Eighteen RCTs (2,599 participants) were included. DSMES interventions did not significantly improve glycemic control, with a pooled mean reduction in HbA1c of -0.25% (95% CI: -0.68 to 0.18; p Conclusion DSMES reveals a non-significant impact on HbA1c reduction in African adults with type 2 diabetes and emphasizes the need for more standardized approaches and broader outcome measures. Future studies should aim to refine DSMES models, enhance patient engagement, and evaluate a wider range of health outcomes to realize the full potential of DSMES in resource-limited settings.