Study Aim Study design Study quality Participant’s demography Key findings Conclusion
Ballotari et al. 2015[@15170] To compare prevalence of diabetes among immigrants and Italians and to evaluate the disparities in the management and glycaemic control. Quantitative approach measuring clinical outcomes of prevalence and HbA1C value 17/20, 85% Citizenship: High Developed Countries (HDC) High Migration Countries (HMC) And High Migration Pressure Countries (HMPC). Sampling: Population-based data Sample size: 17,195. 15,889 Italian, 11 HDC, 1,295 HMPC. Age Range: 20-74. Gender: Male and Female. Context: Italy Foreigners younger with type 2 diabetes than Italians Sub-Saharan Africans with lowest mean age 44.6 years for Female and 44.9years for Male. Both sexes experience a higher prevalence of diabetes than Italian. Lower Italians not performing HbA1C compared to immigrants. Immigrants had worse indicator in HbA1C measure. Higher odds of not being tested for HbA1C than Italians. Immigrants experience higher odds compared to Italians for not being in the care of diabetes clinics, without HbA1C tests in 2010 and with HbA1C >=9%. Confirmation of the higher prevalence of diabetes among immigrants than Italian. Immigrants are less compliant and more likely to experience worse levels of HbA1C
Dreyer et al. 2009[@15180] To establish the impact of ethnicity on the prevalence and severity of diabetes mellitus and Chronic Kidney Disease (CKD) Quantitative Cross-sectional study 17/20, 85% 34,359 Adults coded white black and South Asia population Overall prevalence for white 3.5%, 11% for South Asian and 8% for black population. Diabetic proteinuria was more frequent among Blacks compared to white group (22.4% vs. 14.1%) but similar in South Asia (21% Vs 22%). Lower CKD when compared with white population. Blood pressure is less controlled in black group regardless of CKD, less than 50% of diabetics achieve Bp =< 130/80mmHg. Black population receiving prescription more than South Asia or white groups. Higher level of diabetes among ethnic minority groups was supported with this study. Black population have the worse outcome with higher levels of proteinuria and blood pressure than white and South Asia group. Severe CKD is higher among black and South Asian populations with mild CKD higher among white population.
James et al. 2012[@15178] To describe the independent influence of both ethnic and social group on HbA1C levels in people with type 2 diabetes routinely cared for by general practice for over 5 years. Quantitative Cross-sectional from Web-enabled computer System 18/20, 90% Whites: 5,206 (22%), Black Africa/Caribbean: 3,923 (17%), South Asia: 13,633 (58%) and Others 721 (3%). Age Range: 35-75 years. Sample size: 24,111. White (69%) people were less likely to be on intensive diabetes treatment (Combined oral or Insulin) than South Asia (75%) and black African/Caribbean population (73%). Mean of HbA1C declined in white group by 0.4% from 8.2% to 7.8%: 0.5% for South Asian population and Africa/Caribbean group from 8.5% to 8.0%. The proportion of people with 7.5% or less HbA1C increased by 12% in White group, 14% in South Asia and 15% in Africa/Caribbean groups. There was improvement in HBA1C among all ethnic groups. However, ethnic differences still persisted. Ethnic group and social deprivation are independently associated with HbA1C.
Kahn et al. 2012[@15185] To examine multi-ethnic participants’ explanation of how their diabetes began, understandings about their illness, description of the symptoms experience. To analyse the extent to which themes persisted across ethnic, cultural and racial boundaries Qualitative approach using semi-structured interviews 17/20, 85% Refugee (Somalia, Sudan, Burma or Cuba). Sample Size: 34. Male: 8, Female: 26. Education: 13 secondary school completion Unexpected and late diagnosis of diabetes was reported. Reaction to living with diagnosis was reported as grief, anger, depressive symptoms, and acceptance. Most patients understanding is focused on symptoms and diet People living with diabetes express emotions similar to dying patients. There is a need for practitioners to include patients as partners in the development of patient centred approach to diabetes management
Kindarara et al. 2017[@15186] To describe Sub-Saharan African immigrants’ health-illness transition experiences associated with type 2 diabetes mellitus self-management Qualitative approach using face-to-face semi-structured in-depth interview 18/20, 90% Sub-Sharan African immigrants Sample Size: 10. Mean Age: 60.3 years. Sampling: Purposive and Snowballing Sampling. Male: 5, Female: 5 Participants reported limited knowledge about diabetes. Dealing with the shock of diagnosis with diabetes, cultural beliefs can be inhibitors of self-management Professionals need to access and recognise inhibitors that can influence diabetes self-management.
Kohinor et al. 2011[@15181] To determine the social-cultural factors affecting the dietary behaviour of Dutch Surinamese patients with type 2 diabetes Qualitative approach using Grounded theory methodology 18/20, 90% African Surinamese Hindustani Surinamese. Sample Size: 32. Mean Age: 55. Male: 12 Female: 20 Participants reported finding it difficult to choose good food products, Holding on to their traditional food as identity, culture plays important role in their food preparation. Immigrants continue with their country of origin food and cultural considerations should be involved in advising people with diabetes on dietary recommendations.
Snider et al. 2017[@15174] To explore both the age-specific prevalence of diabetes and the current level of awareness, medical treatment and glycaemic control among different ethnic groups. Quantitative cross-sectional study 18/20, 90% Dutch 4,541, South Asia Surinamese 3,032. African Surinamese 4,109, Ghanaian 2,232, Turkish 3, 591 and Moroccan 3,887. Sample size: 21,483. Sampling: Municipal register. Age range: 18-70 Diabetes prevalence increased among ethnic groups with age. Higher than Dutch and significant from age 31-40 years. There was higher awareness of diabetes (70-80%) among ethnic groups compared to Dutch (60%). The odd for receiving medical treatment for diabetes is also higher among all ethnic minority compared to Dutch. All ethnic minority men are significantly lower odds of controlled HbA1C than Dutch Ethnic groups have higher prevalence of diabetes, although awareness is a higher than among Dutch. There was significant lower control of HbA1C among ethnic minority men than Dutch but no difference among women. There is need to understand the cause of poor glycaemic control among ethnic minority.
Verma et al. 2010[@15175] To determine the impact of quality improvement initiatives on ethnic disparities in diabetes management in the UK Quantitative cross-sectional survey 18/20, 90% 4309 Participants. white population: 13.7%, black population: 16.1%. South Asians: 51.2%, Others: 18.3%. Age: 18 and above. Male: 2393 (55.5%) Female: 1871 (43.4%). No sex: 45 (1.0%) No difference in evidence of the process of care among all ethnic groups The Proportion of patients meeting national treatment targets for Bp, cholesterol and HbA1C increased from 1997-2007. Black patients achieving the targets doubled but still remain less likely to meet target in 2006 compared to white group. Black population were less likely to meet all three targets than white group. South Asians were more likely to meet cholesterol target than white population by 2006. There is increase prescription of lipid-lowering, oral hypoglycaemic agents, insulin and antihypertensive medications since 1997. Increase in prescription medication for black population but lower lipid-lowering medication than white patients in 2006. Black patients were more likely to be on oral hypoglycaemia agent than white population. There has been improvement in patients meeting the three targets since 1997. However, less than 20% were able to meet this target. Medication prescription also increased for all ethnic groups. There is need for better improvement in care and management.
Fosse-Edorh et al. 2014[@15176] To present an overview of type 2 diabetes among North African immigrants in France Quantitative cross-sectional study using national survey 17/20, 85% Race: Africans. France Sample technique: National survey records. Sample size: Born in North Africa (BNA). Male: 191. Born in France (BIF) Male: 5821 BNA (Female) 136. BIF (Female) 6890. Mean Age: BNA (Male) 58. BIF (Male) 61. BNA (Female) 56 BIF (Female) 63. Context: France. Ethnicity: black and white populations. Type 2 diabetes prevalence and obesity is higher among BNA than BIF. HbA1c is also higher among BNA than BIF which indicate poorer control among this population. Although a higher prevalence of type 2 diabetes and poorer glycaemic control was reported among BNA women. There is a poorer control among both Male and Female BNA than BIF contributing to complication disparity among this population
Wieland et al. 2012[@15184] To measure outcomes of diabetes care among Somali immigrants Quantitative methodology 16/20, 80% Race: Somalia And Non-Somalia. Sample technique: Medical record. Sample size: 81. Somalian 5,843, Non-Somalian. Mean Age: not mentioned. Context: USA. Socioeconomic status: Not mentioned. Ethnicity: black population and Others Somalians were less likely to meet the optimum HbA1C control <7%. There was no significant difference in the lipid control level among the Somali and Non- Somali groups. Also, there was no difference in the achievement of blood pressure control between the two groups. There is a disparity in diabetes control among Somali immigrants living with diabetes as compared to Non-Somali groups. This might be due to medical preference, socioeconomic factors, health literacy and culture. Community-practice based intervention is needed to improve diabetes management among this vulnerable population group.
Wallin et al. 2007[@15182] To explore the daily life experience of Somalian diabetic patients living in Sweden with gender-related perspectives to diabetes-related problems management Qualitative methodology Interviews 16/20, 80% Race: Somalian Sample Technique: Not mentioned Sample size: 19 Participants interviewed with interpreter’s help. Mean Age: 54.9 Context: Sweden Socioeconomic status: Not mentioned Ethnicity: black group Experience of distress in daily life as participants find it difficult to maintain daily activities. Difficulty to follow the dietary advice by health professional Cultural consideration is essential in health promotional services for immigrants. Religion and gender consideration is also essential in the prevention and management of diabetes among this ethnic group.
Choukem et al. 2014[@15177] To determine the contribution of migration on the characteristic of Type 2 diabetes comparing three populations living with diabetes Quantitative cross-sectional study design 19/20, 95% Race: Cameroonians, Caucasians. Sample technique: Cross-sectional survey. Sample size: Cameroonian 100, African immigrants 98, Caucasians 199. Age Range: Cameroonian 30-80, African migrant 26-75, Caucasian 28-89. Context: France. Socioeconomic status: Not mentioned. Ethnicity: black and white population Diabetes was diagnosed at a later age among Cameroonian. There were no differences among Cameroonians and African immigrants in mean BMI, overweight, obesity and smoking but higher among Caucasians. Cameroonians had the highest rate of microvascular complications than the other groups. Cameroonians are diagnosed with diabetes at a later age but present with higher complications than African immigrants and Caucasians which might be due to delayed diagnosis and poorer management among the Cameroonian population.
Abubakari et al. 2013[@15171] To investigate diabetes knowledge and illness perception on self-management and also to determine the relationship between self-management behaviour and glycaemic control among African-Origin patients in the UK. Quantitative Methodology 18/20, 90% Race: White British, African Caribbean and black Africans. Sample technique: Convenience sampling. Sample size: 137 white British, 123 African Caribbean and 99 black Africans. Context: UK. Socioeconomic status: Not mentioned. Ethnicity: white and black population. High knowledge about diabetes does not influence better self-management in white group and was related to less self-management in Africans. High Illness perception among white-British was associated with less exercise self-management. In Africans, high illness perception was associated with fewer feet management and dietary regulation. Perceived personal control was related to frequent overall self-management Type 2 diabetes knowledge and perception varies between ethnic groups in the UK which might influence the disease management outcome. These perceptions need to be identified and any misconceptions corrected to allow for efficient self-management recommendations for this population.
Bijlholt et al. 2018[@15173] To asses differences in awareness, treatment and control of diabetes among a relatively homogeneous population from Ghanaians living in \Rural, urban parts of Ghana and Ghanaian immigrants living in European cities Quantitative Cross-sectional study 19/20, 95% Race: Black population. Sample selection: Purposive. Sample size: 530. Amsterdam 172, Berlin 70, London 102, Urban Ghana 135, Rural Ghana 51. Mean Age: Amsterdam 52.2, Berlin 51.1, London 54.6, Urban Ghana 52.9, Rural Ghana 54.5. Gender: Male and Female. Context: Amsterdam, Berlin, London Ghana, Ethnicity: black-Africans (100%) Type 2 diabetes awareness was lowest among people in rural Ghana and highest in European sites (Amsterdam, berlin and London). Diabetes control was similar in Amsterdam, Berlin and rural Ghana but lower in urban Ghana and lowest in London. Although type 2 diabetes awareness and treatment rates were lowest in rural Ghana, type 2 diabetes control was lowest in London and urban Ghana sites.
Brämberg et al 2012[@15183] To describe the care provided by a Diabetes Nurse Specialist (DNS) and the care needs expressed by immigrants living with type 2 diabetes Qualitative observational study 16/20, 80% Race: black Caribbean (BC) and Middle-East. Sample selection: Purposive. Sample size: 10 observation of consultation interview. Gender: Male and Female. Context: Sweden There was power imbalance with patients passive during the consultation. There was limited support provided by DNS in addressing patient’s concerns due to lack of individualised care. There was limited support provided by DNS in addressing patient’s concerns due to lack of individualised care Balanced communication is urgently needed. Person-centred consultation and care for people from immigrant background is seen as an important approach to diabetes management among this population.