PURPOSE : Although self-management education is a key factor in the care for diabetes patients,
its implementation in developing countries is not well documented. This systematic review
considers the published literature on diabetes self-management education in high and low
mortality developing countries. The aim is to provide a state of the art of current practices, assess
program outcomes, cultural sensitivity and accessibility to low literate patients.
METHODS : The Cochrane Library, PubMed, MEDLINE, PsycInfo and PsycArticles databases
were searched for peer-reviewed articles on Type 2 diabetes published in English between 2009
and 2013. The World Bank and WHO burden of disease criteria were applied to distinguish
between developing countries with high and low mortality. Information was extracted using a
RESULTS : Three reviews and 23 primary studies were identified, 18 of which were from low
mortality developing countries. Studies from high mortality countries were mostly quasiexperimental,
those from low mortality countries experimental. Interventions were generally
effective on behavior change and patients’ glycemic control in the short term (≤9 months). While
57% of the studies mentioned cultural tailoring of interventions, only 17% reported on training
of providers, and 39% were designed to be accessible for people with low literacy.
CONCLUSIONS : The limited studies available suggest that diabetes self-management education
programs in developing countries are effective in the short term, but must be tailored to conform
to the cultural aspects of the target population.