Prevention of type 2 diabetes mellitus among people with Middle Eastern backgrounds living in high-income countries: a systematic review

Objectives: This systematic review aims to assess the available evidence on the prevention of type 2 diabetes mellitus (T2DM) among Middle Eastern (ME) populations residing in high-income countries (HICs). The review focuses on two key aspects: (1) evaluating the efficacy of interventions for improving health outcomes and (2) examining the barriers to and facilitators of the implementation and effectiveness of interventions.

Design: Systematic review.

Data sources: MEDLINE, ProQuest Central and Scopus were searched between 10 September 2023 and 10 October 2023.

Eligibility criteria: Studies published in English from 2000 to 2023 involving ME populations residing in HICs who are prediabetic or at high risk of T2DM. Interventions included behavioural, pharmacological and educational strategies, with outcomes assessed in terms of diabetes incidence, lifestyle changes and healthcare utilisation, as well as barriers and facilitators of intervention effectiveness.

Data extraction and synthesis: Data were extracted and synthesised based on study design, geographical location, participant characteristics, type of approach and key outcomes. A narrative synthesis was used to identify patterns in intervention effectiveness, barriers (eg, cultural and gender norms, language) and facilitators (eg, family support, religious considerations).

Results: 20 studies were included and categorised into two groups: interventional studies (randomised controlled trials and quasi-experimental designs) and qualitative and cross-sectional studies. Interventional studies demonstrated significant improvements in health outcomes, including weight loss, increases in physical activity and improved cardiometabolic markers. Qualitative studies revealed important insights into the sociocultural factors facilitating T2DM prevention that must be considered for effective interventions, including gender norms, family dynamics (relations, interactions, etc) and religious beliefs, with barriers including language, lack of health insurance, unaffordable financial costs and social isolation.

Conclusions: This systematic review highlights the effectiveness of culturally sensitive interventions in preventing T2DM among ME populations in HICs. It emphasises a need for co-designed, culturally appropriate interventions that involve people from ME populations in HIC with lived experience of T2DM, healthcare providers and community stakeholders.

Prospero registration number: PROSPERO, CRD42023457123.