Lay Health Worker Led Diabetes Task-Sharing Intervention in Middle-Income Countries: A Systematic Review and Meta-Analysis

Abstract

Background: Task-sharing in diabetes management may be useful for health systems in staff- and resource-poor middle-income countries. The study evaluated the effectiveness of a task-sharing intervention for diabetes led by non-professional health workers in improving glycaemic indicators and blood pressure among adults in middle-income countries.

Methods: Embase, PubMed, MEDLINE and Cochrane Central Registry of Controlled Trials were searched for studies published from 2010-2022. Intervention studies involving task-sharing strategies for managing diabetes and other cardiovascular risk factors were included. Extracts were made on populations, interventions, and lay health worker training and supervision. The quality of studies was assessed using the Cochrane Risk of Bias tool. Performed a meta-analysis of randomised controlled trials. A random-effects model was used due to significant heterogeneity among the studies (I² ≥ 50%), otherwise, a fixed-effect model was used.

Results: Thirteen randomised controlled trials with 8183 patients were included in the meta-analysis. The population average pooled mean difference in HbA1c was -0.17% (95% CI -0.34 to -0.01) and in fasting blood glucose was -0.75 mmol/L (95% CI -1.14 to -0.35). The population average pooled mean difference in systolic blood pressure was -5.90 mmHg (95% CI -8.11 to -3.68) and in diastolic blood pressure was -2.25 mmHg (95% CI -3.10 to -1.40).

Conclusion: Task-sharing interventions for diabetes led by lay health workers in middle-income countries have shown potential for lowering blood glucose levels and reducing blood pressure.