Effectiveness of non-pharmacological strategies in management of type 2 Diabetes in primary care: a protocol for a systematic review and network meta-analysis

Abstract

Despite the increasing number of drugs and various guidelines on the management of type 2 diabetes (T2DM), many patients continue with the disease uncontrolled. There are several non-pharmacological treatments available for managing T2DM, but many of them have never been compared directly to determine the best strategies. Objective: This study will evaluate the comparative effectiveness of non-pharmacological strategies in the management of T2DM in primary care or community settings. The selected strategies did not substitute pharmaceutical treatment but instead focused on promoting in diabetic patients a greater commitment to this condition and consequently a better control of their disease Methods and Analysis: We will perform a systematic review and network meta-analysis (NMA), and will include randomized controlled trials if one of the following interventions were applied in adult T2DM patients: nutritional therapy, physical activity, psychological interventions, social interventions, multidisciplinary lifestyle interventions, diabetes self-management education and support (DSMES), technology-enabled DSMES, interventions delivered only either by pharmacists or by nurses, self-blood glucose monitoring in non-insulin-treated T2DM, health coaching, benchmarking, and conventional management of T2DM. The primary outcomes will be glycemic control (HbA1c levels during the follow-up). Four general and adaptive search strategies have been created for Embase, Medline, LILACS, and CENTRAL. Four reviewers will in pairs and independently assess studies for their eligibility, risk of bias, as well as will extract data from included studies. We will conduct a NMA using a Bayesian hierarchical model, and will obtain the treatment hierarchy using the surface under the cumulative ranking (SUCRA) curve. To determine our confidence in an overall treatment ranking from the NMA we will follow the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. (AU)