Introduction
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What are the existing interventions for managing diabetes amongst homeless adults?
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What are the principles and barriers to successful management of diabetes in homeless adults with this disease?
Method
Eligibility criteria
Inclusion criteria | |
Types of studies | Studies investigating the management of diabetes amongst homeless adults |
Studies written in English | |
Studies conducted in any year | |
Full-length studies published in peer review journals | |
Primary studies, using either retrospective or prospective design or either quantitative and/or qualitative design (studies with measurable outcomes); including clinical trials quasi experimental studies | |
Types of interventions | Studies were included if the outcomes were measured for the diabetes management intervention and consisted of adults who has Type 2 diabetes (age ≥ 16 years) |
Types of outcome measures | Studies were included if the intervention outcomes included one or more of the following: Glycaemic control: HbA1c, blood glucose levels Cardiovascular risk factors (e.g. Cholesterol, blood pressure, weight, BMI and serum creatinine Mortality Hospital admissions |
Studies were also included if the intervention outcomes included self-reported measures such as: Diet improvement Patient satisfaction Well-being, quality of life, perceived health scores on a validated generic or disease specific measure Medication adherence | |
Exclusion criteria | |
Types of studies | Non English language |
If it was a commentary, editorial or case study on transition | |
The primary focus was not the management of diabetes among homeless adults | |
Types of interventions | Participants without a diagnosis of Type 2 diabetes |
Participants who are not categorised as homeless | |
Participants younger than 16 years of age, which included trials that involved both children and adults | |
Specifically targeted healthcare professionals | |
Focused specifically on the management of being homeless | |
Types of outcome measures | Focused specifically on the prevalence of diabetes |
Focused solely on the clinical improvements as the only outcome measure (because management interventions can also be targeted towards behaviour change, which does not always lead to clinical improvements) |
Search strategy
Study selection
Data extraction and study quality
Authors (year) | Research aims | Sample size (%male) %Homeless | Mean age (range) | Setting | Description of intervention | Assessment of intervention | Key results | Quality score1 |
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Thompson et al. (2014) | Assess the effectiveness of the GMV program for individuals with a diagnosis of diabetes or at risk of developing diabetes | 52 participants in GMV program. 9 took part in interviews (100%) 100% | 54.5 years (46–62) | Community health Care in Canada | The intervention consisted of monthly GMV’s. Each session included group discussion of a topic relating to diabetes management, medical care, an evaluation of behavioural goals | Semi-structured interviews | Participants described how the group medical visits programme was implemented, their thoughts on the qualities of a good facilitator. Also what the role of the group members had in supporting their behaviour change in diabetes management and provided feedback and suggestions for improvement | 14 |
Davachi and Ferrari (2012) | To identify the barriers that could impact the homeless participants’ ability to manage their diabetes To develop an accessible and effective diabetes management support for the homeless population especially those at risk or already diagnosed with diabetes | 524 (74%) 100% | Not recorded (≥ 18 years) | Calgary Drop-in & Rehab Centre (CDIRC) in Canada | The project for the management support included components such as diabetes awareness, screening, group visits and also individual case management | A reduction in participants fasting blood glucose (FBG) and their HbA1c levels. Which will be measured at 3 and 12 months | Amongst the 524 participants’ screened, 11% were found to have pre-existing diabetes, 16% had high blood glucose levels Baseline results and results captured at the 3 to 12 months follow-ups were only available for 10 patients with pre-existing diabetes. However although the low numbers of follow-up data collected, the mean reductions in FBG of 4 mmol/L and HbA1c of 1.1% is significant for this population | 21 |
Pauley et al. (2016) | To evaluate the feasibility of cluster care and a supportive housing model integrated for the participants | 212 (35%) 100% Participants with Diabetes (8%) | 55.5 years (37–76) | Three participating supportive inner-city housing facilities in Toronto, Canada | Integration of cluster care and supportive housing models. In the supportive housing model, services and housing are combined in the same location Components of cluster care included the following: (1) care at a given site is provided by a single provider agency. (2) The agency deploys teams of care providers instead of individual workers. (3) Care plans are structured on the basis of assessment and care plan specific tasks rather than block of time | Goal attainment scale and interviews | During a 15 month period, 20 clients received this service (pre-implementation). Which increased to 147 clients (post-implementation) during a 16 month period, with a 60% reduction in cost The results shows that regular team meetings promoted efficient service delivery; greater client satisfaction associated with goal achievement and finally reported client satisfaction where staff and client goals were aligned closely together | 17 |
Beggs and Karst (2016) | To assess the effectiveness of an education programme led by pharmacy students with adults experiencing homelessness | 17 pharmacy students (NR) 0% Participants with diabetes 8 (100%) 100% | NR | Local outreach organisation in Nashville, USA | Bingo games focused on a wide variety of questions related to the health topic, including basics of the disease, anatomy, statistics, medicines, diet, lifestyle, environmental concerns, and common misconceptions. Each group led a one-hour class using Bingo games over one week | Survey | In total 37 surveys were completed. The results showed that the classes led by pharmacy students were effective in increasing the knowledge of each of the health topics presented. All participants stated they would attend future classes that are led by pharmacy students | 15 |
O’Toole et al. (2010) | To determine if a population tailored approach delivered to homeless veterans of how primary care is organised would lead to better health care and outcomes | Homeless: 79 (96%) 100% Control: 98 (96.7%) 100% | Homeless: 51.8 SD = 0.94 (NR) Control: 52.9 SD = 7.7 (NR) | The participants in the intervention group voluntarily enrolled in a homeless oriented primary care clinic, located in Providence VA Medical Centre (USA) Participants within the control group were new to primary care | The Homeless- Oriented Primary Care Clinic was structured to address 4 core elements of the chronic care model specifically tailored to homeless persons. The clinic had an open-access care model with onsite services that included food, housing assistance, clothes and veterans’ benefits | Clinical assessment measures such as blood pressure checks for hypertension, HbA1c for diabetes, and low density lipoprotein [LDL] | The patients showed improvements in their hypertension, diabetes and in lipid control. The use of the primary care was higher during the initial 6 months but started to stabilise 6 months after The use of the emergency department also saw an increase, although there was a 40% decrease in the non-acute emergency department visits Excluding the abuse of substances and admissions due to mental health, hospitalisations decreased amongst the homeless veterans in the 2 6 months periods compared to the control group | 26 |
Savage et al. (2014) | To examine the rate of retention in homeless adults and investigating the feasibility of a CDSM diabetes intervention | 9 (NR) 100% | NR | The participants were recruited through a nurse-led clinic for homeless people in Ohio (USA) | The intervention included the use of educational sessions with the integration of behaviour change strategies. In addition the intervention also included the use of assessments led by nurses and outcomes achievements | Surveys were conducted at baseline and also at 12 weeks Participants’ self-efficacy was measured using the Managing chronic Disease questionnaire Health behaviours was measured using a cognitive symptom management questionnaire and a communication with physicians’ questionnaire | Only 5 out of the 9 participants stayed for the full 12 weeks, whilst 2 out of 3 participants completed the intervention | 16 |