Effects of community health worker on diabetic control among adult patients with type 2 diabetes mellitus : a systematic review

Abstract

Objective The epidemic of Type 2 diabetes mellitus (T2DM) has become a significant threat and a major public health problem worldwide, including China. However, diabetes care in China is suboptimal due to shortage of medical facilities and unaffordable health care cost. Community health worker (CHW) intervention is one of key practical recommendations to assist health care professionals in guiding type 2 diabetes patients to achieve recommended glycaemic goal, especially those who have inadequate access to health services. This systematic review evaluated the effects of CHW intervention on improving glycosylated hemoglobin (HbA1c) of adult patients with T2DM. Research design and methods PubMed database was searched using keywords, “Community health worker OR Community health promoter OR Community health representative OR Health promoter OR Outreach educator OR Village health worker” AND “Type 2 diabetes” AND “Community”. All relevant articles were identified using inclusion and exclusion criteria. The outcome of interest was HbA1c. Results In this systematic review, 9 randomized controlled trials (RCTs) identified the effects of CHW on diabetic control among adult patients with T2DM. All studies come to a common conclusion --- CHW intervention played a significant role in controlling HbA1c in adult patients with T2DM with medically underserved. The health outcomes of CHW intervention were even maintained at 5-10-20-year horizon. Conclusion This systematic review was probed for a strong evidence that effects of CHW on diabetic control among adult patients with T2DM. All included studies drew a similar robust conclusion that CHW contribute significant value to control diabetes. Affirmatively, the incidence and prevalence of diabetes is currently on an increasing trend worldwide, especially in China. Poor glycemic control ends up with preventable complications. Subsequently the burden in diabetes care would be doubled, or even tripled. It is time we review the current strategy of diabetes management in China. CHW intervention should be considered as one of the innovative strategies to in China health care system. It would benefit especially urban poor Chinese.