(a) |
| | Citation/level and quality | Purpose | Sample/setting | Design | Results/conclusion | Recommendations |
| Ganiyu et al., [29]
Johns Hopkins level: III
Quality: high quality | To investigate the barriers for nonadherence to the recommended diet and exercise among type 2 diabetes mellitus patients | The sample size was 96 with age greater than 30 years over a period of 3 successive months.
Extension II clinic, in Gaborone, Botswana. | Institutional-based cross-sectional study.
Data was collected using self-administered questionnaire | The main barriers for nonadherence to the recommended diet were poor self-discipline, lack of awareness, eating outside home, economic constraints and lack of self-control.
The main barriers for nonadherence to the recommended exercise were poor knowledge, perceived exercise as potentially exacerbating illness, lack of exercise partner, specific locations away from home, and winter weather. | Awareness creation regarding the effectiveness of diet and exercise should be delivered through diabetes education program using different motivational interviewing models.
Multiple strategies such as creating support group and increasing awareness programs for diet and exercise recommendations should be included in primary health care. |
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(b) |
| | Citation/level and Quality | Purpose | Sample/setting | Design | Results/conclusion | Recommendations |
| Ayele et al., [30]
Johns Hopkins level: III
Quality: high quality | To examine the barriers for dietary adherence among patients with type 2 diabetes | Patients with T2DM aged >18 years who visited the hospital for follow-up from August 1–October 30–2017
In Debre Tabor General Hospital, Northwest Ethiopia | Institutional-based cross-sectional study.
The Perceived Dietary Adherence Questionnaire (PDAQ) tool was used for dietary adherence measurement | Nonadherence to recommended diet among T2DM is high. 74.3% of the patients reporting nonadherence.
The barriers for the high rate of poor adherence were poor knowledge, lack of education on diet, and financial constraints on the recommended diet, low income, lack of previous exposure to dietary education and the presence of other chronic illness. | Health workers should become effective in addressing these barriers through guiding and teaching patients.
Health care decision makers should follow effective dietary guidelines for people with T2DM. |
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(c) |
| | Citation/level and quality | Purpose | Sample/setting | Design | Results/conclusion | Recommendations |
| Assaad-Khalil et al., [31]
Johns Hopkins level: III
Quality: high quality | To investigate the potential barriers to diabetes care delivery in the Middle East and South Africa. | One thousand and eighty-two physicians
Countries in the Middle East and Africa (Egypt, Kingdom of Saudi Arabia, United Arab Emirates, South Africa, and Lebanon) | Descriptive cross-sectional study. | Poor lifestyle adherence, illiteracy, and patients’ poor diet were the main barriers for diabetes prevention and management. | Future research should be conducted to numerically measure the impact of these barriers on the delivery of diabetes care. |
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(d) |
| | Citation/level and quality | Purpose | Sample/setting | Design | Results/conclusion | Recommendations |
| Muhabuura, [32]
Johns Hopkins level: III
Quality: high quality | To determine the knowledge of the role of diet and exercise lifestyle recommendations, prevalence of nonadherence to diet and exercise recommendations, and describe the factors associated with nonadherence to diet and exercise among type 2 diabetic patients | The total sample size was 324 participants with age greater than 30 years
In Kenyatta National Hospital (KNH) diabetic clinic | Descriptive cross- sectional study
A structured, pilot-tested questionnaire was used to collect data. | The results from this study demonstrated lower rates of nonadherence to diet and exercise recommendations among people diagnosed with type 2 diabetes mellitus
Financial constraints and lack of detailed written instructions regarding diet as reasons for nonadherence to diet while reasons for nonadherence to exercise were lack of information and belief that exercise potentially exacerbates illness. | There is a need for active involvement of family and friends of diabetic patients in management of type 2 diabetes.
Detailed written instructions on proper diet and exercise should be tailored to individual patients taking into account other factors such as presence of other co morbidities. |
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(e) |
| | Citation/level and quality | Purpose | Sample/setting | Design | Results/conclusion | Recommendations |
| Schellenberget al., [23]
Johns Hopkins level: I
Quality: high quality | To review the importance of lifestyle interventions on decreasing progression to diabetes in high-risk patients or progression to complications such as (cardiovascular disease and death). | Nine RCTs on at risk for diabetes and eleven on patients who had diabetes
Publications conducted in patients with type 2 diabetes in the world | Systematic review and meta-analysis of RCTs. | Comprehensive lifestyle interventions including diet and physical exercise effectively decrease the incidence of type 2 diabetes. There was no evidence on reducing mortality in patients who already have type 2 diabetes and insufficient evidence on reducing complication | The review included only RCTs studies.
A review of cohort studies is advantageous to provide data on the effect of different lifestyle interventions |
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(f) |
| | Citation/level and Quality | Purpose | Sample/setting | Design | Results/conclusion | Recommendations |
| Rawal, et al. [42]
Johns Hopkins level: I
Quality: high quality | To review the cost-effectiveness of nonpharmacological interventions aimed at preventing T2DM and its related complications in developing countries such as Africa and Asia. | Nine studies were included in this review
Publications conducted in patients with type 2 diabetes in developing countries. | Systematic review of RCTs. | The result of the review showed a significant reduction in the development of T2DM in the intervention group compared with controls.
The study comprised three lifestyle intervention groups (diet, exercise, and diet + exercise), with one control group with no life style intervention measures. | Future programs should focus on the appropriate development, adaptation, and implementation of efficacious, cost-effective intervention methods through health education and promotion, and creating support group. |
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(g) |
| | Citation/level and quality | Purpose | Sample/setting | Design | Results/conclusion | Recommendations |
| Ayele, et al. [26]
Johns Hopkins level: III
Quality: good | To identify predictors of self-care behaviors among patients with diabetes. | Two hundred twenty two T2DM patients.
Three hospitals in Harar town, Ethiopia. | Quantitative cross-sectional study | Patients with poor information were less likely to adhere to diabetes self-care. Patients, who were more educated, middle income, had high-perceived severity of diabetes and less perceived barrier to self-care were more likely to take diabetes self-care. | To increase the awareness on self-care behavior, diabetes education should focus on severity of diabetes and how to overcome the barriers for self-care. |
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(h) |
| | Citation/level and quality | Purpose | Sample/setting | Design | Results/conclusion | Recommendations |
| Alouki, et al. [24]
Johns Hopkins level: I
Quality: high quality | To investigate key findings of economic evaluations of lifestyle interventions for the primary prevention of type 2 diabetes (T2D) in high-risk subjects | 20 articles were included.
7 were RCTs and 13 using modeling techniques.
Publications conducted in patients with type 2 diabetes since January 2009. | Systematic review of RCTs | The importance of lifestyle interventions combining diet and physical activity to prevent diabetes in at-risk population groups. | Lifestyle interventions should be further stressed as an effective strategy to prevent or delay diabetes through creating effective and efficient diabetes education. |
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(i) |
| | Citation/level and quality | Purpose | Sample/setting | Design | Results/conclusion | Recommendations |
| Tewahido & Berhane [27]
Johns Hopkins level III
Quality: high quality | To describe self-care practices among individuals with type II diabetes in Addis Ababa, Ethiopia. | Type 2 diabetes between the ages of 35-65 years that came to follow up clinics from November 2013 to February 2014.
A purposive sampling procedure
Type II diabetes patients in Addis Ababa, Ethiopia. | A qualitative method of descriptive cross-sectional study | The review showed that self-care habits of patients were not adequate.
Most of the patients were inadequately adhered to the recommended dietary and physical exercise.
Diabetes patients mainly dependent on prescribed medications to control their glycemic level. | Attention should be given to improve patient diabetes self-management education and support to reduce diabetes related complications. |
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(j) |
| | Citation/level and quality | Purpose | Sample/setting | Design | Results/conclusion | Recommendations |
| Rahati, et al. [25]
Johns Hopkins level II
Quality: high quality | To investigate evidence regarding epidemiologic and clinical trial. | Systematic review of articles.
Publications conducted in patients with type 2 diabetes in Middle east and Africa | Systematic review without meta-analysis | The lifestyle and dietary habits in low-income countries are changing towards risky behavior such as physical inactivity due to use of transportation, and urbanization that change people eating habit towards fast-food. | Interventions should be specified for each age group category and their developmental stages. |
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(k) |
| | Citation/level and quality | Purpose | Sample/setting | Design | Results/conclusion | Recommendations |
| Mutyambizi, et al. [28]
Johns Hopkins level II
Quality: high quality | To investigate the cost of diabetes in Africa. | Systematic review of twenty six articles were reviewed
Publications conducted in Africa | Systematic review | The diabetes related direct costs differed between countries. The most commonly listed healthcare costs were pharmaceutical costs, followed by diagnostic and investigation costs, medical equipment supply costs and consultation costs.
Estimation of the costs associated with diabetes is important to achieve the targets in SDG3 set by 2030. | Future research should focus on increasing the transparency and methodological principles of cost of illness studies. |
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(l) |
| | Citation/level and quality | Purpose | Sample/setting | Design | Results/conclusion | Recommendations |
| Belue, et al. [33]
Johns Hopkins level: III
Quality: good quality | To examine diabetes patients experience on diabetes self-management among clinic patients. | 195,000 patients were included in the Grand M’bour Medical Clinic during the summer of 2009 and 2010.
The Grand M’bour Medical Clinic in Senegal. | Qualitative study with the PEN-3 model using semistructured interview.
The PEN-3 model consists of three interrelated domains: relationships, expectations, cultural empowerment, and cultural identity. | Lack of adequate finance to access health care and to follow the recommended diabetic diet by the health care professionals were the main barriers to diabetes management.
Family and significant others have significant positive and negative role in the management of diabetes. | Since participants were only those who seek health care, those who do not have access to health care were not included. Further approach should be investigated to include all patients and other studies should be conducted using objective measures of diabetes control to avoid bias. |
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(m) |
| | Citation/level and quality | Purpose | Sample/setting | Design | Results/conclusion | Recommendations |
| Mendenhall and Norris [34]
Johns Hopkins level: III
Quality: good quality | To examine opportunities and challenges of diabetes care of low-income women in South Africa. | 27 women diabetic patients were included
In Chris Hani Baragwaneth Hospital in Soweto, South Africa. | Qualitative study conducted through 27 face to face interview of patients | Lack of education on diabetes, not following diabetes treatment routines, structural barriers to clinics, and poor access to medications are the main barriers of diabetes management with patients.
Lack of continuous diabetes counseling, drug availability, quality of care, and patient wait times affect patient frustration and lack of confidence in the public health care system | Community-based care by mobilizing community resources and further health care education is necessary for better control of diabetes. |
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(n) |
| | Citation/level and quality | Purpose | Sample/setting | Design | Results/conclusion | Recommendations |
| Chang, et al. [35]
Johns Hopkins level: III
Quality: good quality | To investigate the challenges to hypertension and diabetes care in rural Uganda. | 16,694 adults’ patients were included from different clinical departments.
Conducted in Nakaseke District, Uganda. | Qualitative study with semi-structured face-to-face in-depth interviews were conducted | The main barriers for nonadherence to diabetes treatment are poor knowledge regarding the prevention of chronic diseases such as HTN and DM, patients’ mistrust of the healthcare system, and skepticism from health care professionals (HCPs) and village health-care team (VHTs’). | Further education should be delivered concerning HTN and DM
Screening activities through the collaboration of health care providers, community workers, and village health care team is useful to overcome the barrier. |
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