Factors influencing the effective management of diabetes during humanitarian crises in low- and middle-income countries: a systematic review

Objectives: The management of non-communicable chronic diseases such as diabetes mellitus is often poor in humanitarian crisis settings. Poor disease management can have serious long-term consequences. This review sought to identify studies that explored the effectiveness of interventions and the determinants that may improve the management of diabetes in the humanitarian context. Study design: A systematic review was conducted of all types of studies that implemented diabetes programmes in humanitarian settings. Methods: MEDLINE, Embase, CINAHL and Web of Science were searched for relevant articles using multiple search terms for relevant studies published in English between 2000 and June 2020. Quality assessments using valid tools, were conducted. A narrative synthesis of the findings was then performed. Results: The search yielded 550 citations. After de-duplicating and screening, 19 studies were eligible for inclusion. Most studies were conducted in the Middle East (74%), Asia (16%) and Africa (10%). The interventions reported to improved diabetes care included the mHealth tool, intensive lifestyle intervention, task-shifting, psychosocial support, distribution of glucometers and comprehensive care. Insufficient drug supply, out-of-pocket cost, the complexity of insulin therapy and low adherence to guidelines were identified as barriers. Conclusion: There is a paucity of evidence on optimal diabetes care in acute crisis and natural disaster settings. The review was constrained by the low quality of the studies included. Nevertheless, it is likely that mHealth can be feasibly utilised, as educational SMS messages are cost-effective and electronic medical records can enhance disease monitoring. In addition, a multidisciplinary approach to care improves glycaemic control and is desirable due to the multifaceted nature of the disease and management required. Several key barriers have been identified that need to be tackled. Overall, the evidence base for diabetes care in humanitarian settings remains sparse, and further research is needed. (c) 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Automated summary

This review examined the effectiveness of interventions for managing diabetes in humanitarian settings, identifying various strategies such as mHealth tools and lifestyle interventions. Barriers to care, including insufficient drug supply and treatment complexity, were also highlighted. The evidence base for diabetes care in humanitarian settings remains limited, underscoring the need for further research.