J. Biomedical Science and Engineering, 2013, 6, 36-44 JBiSE http://dx.doi.org/10.4236/jbise.2013.65A007 Published Online May 2013 (http://www.scirp.org/journal/jbise/ ) Efficacy of non-pharmacological interventions in controlling type 2 diabetes in patients of African descent: A systematic review Takira Glasgow 1 , Liz Cheek 2 , Naji Tabet 1* 1 Postgraduate Medicine, Division of Medical Education, Brighton and Sussex Medical School, Brighton, UK 2 Computing, Engineering and Mathematics, University of Brighton, Brighton, UK Email: * n.t.tabet@brighton.ac.uk Received 10 March 2013; revised 11 April 2013; accepted 12 May 2013 Copyright © 2013 Takira Glasgow et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Purpose: The purpose of this review is to systemati- cally assess the potential effectiveness of targeted educational and other non-pharmacological interven- tions on diabetes control in populations of African descent in developed countries. Such information can inform intervention strategies and highlight evidence- based approaches to deal with this significant prob- lem in this population. Methods: A systematic review and a meta-analysis of random controlled trials and cohort studies evaluating the influence of education and other non-pharmacological interventions on HbA1C concentrations in patients of African descent with diabetes. A comprehensive search of PubMed, EMBASE, CINAHL, ZETOC, SIGLE databases was carried out. Results: Although nine studies (8 ran- domised controlled trials and 1 cohort study) met the inclusion criteria, relevant HbA1C data were avail- able for 6 of the studies for the subsequent meta- analysis. Heterogeneity of meta-analysis was high (I 2 = 92%), the random effects pooled standard mean difference favoured the intervention −0.66 (−1.15, −0.17), p = 0.009. After sensitivity analysis, I 2 re- mained moderate to high at 69%. The random effects pooled standard mean difference continued to favour the intervention −0.48 (−0.81, −0.16), p = 0.009. Con- clusion: There is evidence supporting the efficacy of educational and other non-pharmacological interven- tions in diabetes control in populations of African descent in English speaking developed countries. This conclusion is tempered by the significant heterogene- ity of selected interventions and paucity of high qual- ity research in the target population. Keywords: Diabetes; Education; African Descent; Non-Pharmacological Intervention; HbA1C 1. INTRODUCTION Estimates by the WHO demonstrate the scope of the diabetes challenge: 438 million people world-wide will have diabetes by 2030, and one in three Americans will have the disease by 2050 [1,2]. The prevalence of diabetes is much higher among populations of African descent in developed countries. In the USA, for example, African Americans are twice as likely to be diagnosed with dia- betes (prevalence of 11.8%) and a third of cases are un- diagnosed. Further, among African Americans type 2 diabetes accounts for 90% to 95% of all cases [3]. In the UK, it was estimated that the African Caribbean popula- tion had a prevalence of diabetes three times greater than the general population in 2006 [4]. Alongside the high prevalence of diabetes among pa- tients from African ancestry in developed countries, in- creased complication rates are also reported. In the US, the National Health and Nutrition Examination Survey (NHANES) 1971-1992 prospective analysis of the am- putation rates of a 14,407 cohort concluded that African American participants (2199 in number) underwent 2.8 times more amputations compared to their white coun- terparts [5]. Feinglass and colleagues further stated that males of African ancestry were 1.7 times more likely to experience primary and repeat amputations [6]. Likewise, the prevalence of diabetic retinopathy and macular oe- dema was also higher in participants from African ances- try with diabetes (36.7% and 11.1% compared to 24.8% and 2.7% among white, and 25.7% and 8.9% among Chinese patients respectively) [7]. In a different study Gulliford and colleagues determined that the prevalence of sight-threatening diabetic retinopathy was 15.2% in g* Corresponding author. OPEN ACCESS