Systems, Social, and Individual Factors Influencing Glycemic Control Among American Indian/Alaska Native Adults with...

OBJECTIVES : American Indian/Alaska Native (AI/AN) peoples experience type 2 diabetes (T2DM) at double the rate of White Americans and have 2.3 times greater mortality. Glycemic control is a central goal of diabetes management and is associated with superior physical outcomes and quality of life. The purpose of this systematic review was to identify and synthesize all factors that influence glycemic control among AI/AN people with T2DM.

This is a systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. PubMed, CINAHL, PsychInfo, Embase and Web of Science were searched using terms related to "type 2 diabetes" and "American Indian/Alaska Native" from 2008-2023.

Thirty-three studies were identified. Factors related to glycemic control were 1) healthcare interventions, 2) social determinants of health, 3) self-care behaviors, 4) mental health and psychological factors, and 5) genetic factors. Few factors were consistently associated with improved glycemic control. Multidisciplinary care models that integrate community members providing education/healthcare referrals, and medication adherence had the strongest signals with improved glycemic control. While some studies found relationships between glycemic control and diet, exercise and depression, others did not.

While more work is needed to understand influencers of glycemic control in this population, community health representatives, medication adherence and healthcare utilization should be leveraged to improve glycemic control. Future work among AI/AN people with T2DM should focus on how structural and societal factors, like health policy, built environment, and social environment, impact the performance of self-care behaviors and influence glycemic control.