Article Text

Lifestyle interventions for type 2 diabetes management among migrants and ethnic minorities living in industrialized countries: a systematic review and meta-analyses
  1. Lal Rawal1,2,3,4,
  2. Berhe W Sahle5,6,7,
  3. Ben J Smith8,
  4. Kie Kanda9,
  5. Ebenezer Owusu-Addo10,
  6. Andre M N Renzaho3,11
  1. 1School of Health Medical and Applied Sciences, Collage of Science and Sustainability, Central Queensland University—Sydney Campus, Sydney, New South Wales, Australia
  2. 2Physical Activity Research Group, Appleton Institute, Central Queensland University, Adelaide, South Australia, Australia
  3. 3Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
  4. 4School of Social Sciences, Western Sydney University, Sydney, New South Wales, Australia
  5. 5Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  6. 6School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
  7. 7Centre for Quality and Patient Safety Research (QPS), Alfred Health Partnership, Melbourne, Victoria, Australia
  8. 8Prevention and Health Promotion, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
  9. 9School of Nursing and Midwifery, Western Sydney University, Liverpool, New South Wales, Australia
  10. 10Bureau of Integrated Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  11. 11School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
  1. Correspondence to Dr Lal Rawal; dr.lalrawal{at}


The objective of this systematic review was to determine the effectiveness of lifestyle interventions to improve the management of type 2 diabetes mellitus (T2DM) among migrants and ethnic minorities. Major searched databases included MEDLINE (via PubMed), EMBASE (via Ovid) and CINAHL. The selection of studies and data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the meta-analysis, significant heterogeneity was detected among the studies (I2 >50%), and hence a random effects model was used. Subgroup analyses were performed to compare the effect of lifestyle interventions according to intervention approaches (peer-led vs community health workers (CHWs)-led). A total of 17 studies were included in this review which used interventions delivered by CHWs or peer supporters or combination of both. The majority of the studies assessed effectiveness of key primary (hemoglobin (HbA1c), lipids, fasting plasma glucose) and secondary outcomes (weight, body mass index, blood pressure, physical activity, alcohol consumption, tobacco smoking, food habits and healthcare utilization). Meta-analyses showed lifestyle interventions were associated with a small but statistically significant reduction in HbA1c level (−0.18%; 95% CI −0.32% to −0.04%, p=0.031). In subgroup analyses, the peer-led interventions showed relatively better HbA1c improvement than CHW-led interventions, but the difference was not statistically significant (p=0.379). Seven studies presented intervention costs, which ranged from US$131 to US$461 per participant per year. We conclude that lifestyle interventions using either CHWs or peer supporters or a combination of both have shown modest effectiveness for T2DM management among migrants of different background and origin and ethnic minorities. The evidence base is promising in terms of developing culturally appropriate, clinically sound and cost-effective intervention approaches to respond to the growing and diverse migrants and ethnic minorities affected by diabetes worldwide.

  • diabetes mellitus
  • type 2
  • self-management

Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information. Data are available in a public, open access repository.

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Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information. Data are available in a public, open access repository.

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  • Contributors LR, BWS, BJS, KK and AMNR contributed conceptualizing the study, drafting the manuscript and finalization. LR, BWS and AMNR contributed in data search, assessment, analyses and results write up. BJS, KK, EO-A and AMNR thoroughly reviewed the manuscript and contributed substantially for necessary revision. LR, BWS, BJS, KK, EO-A and AMNR finally reviewed the manuscript and prepared for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.