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Multilevel Diabetes Prevention Interventions to Address Population Inequities in Diabetes Risk: Scoping Review.

Reshma Patel1, Kathy Kornas1, David Gerstle2

  • 1Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T1P8, Canada, 1 4169786064.

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Multilevel diabetes prevention interventions show promise for reducing health inequities. However, studies rarely measure equity outcomes, highlighting a need for future research to focus on impacts for disadvantaged populations.

Keywords:
health equitymultilevel interventionpreventionreviewtype 2 diabetes

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Area of Science:

  • Public Health
  • Health Equity Research
  • Diabetes Prevention Science

Background:

  • Type 2 diabetes disproportionately affects marginalized communities due to social, economic, and environmental determinants.
  • Individual-focused prevention strategies often neglect multilevel socioecological factors contributing to diabetes risk and inequities.
  • Multilevel interventions addressing various health determinants offer a promising approach to reduce diabetes risk inequities.

Purpose of the Study:

  • To systematically map health determinants in multilevel diabetes prevention interventions targeting population inequities.
  • To evaluate the existing evidence on the effectiveness of these interventions.

Main Methods:

  • Scoping review of studies from 2000-2024 using multiple databases and gray literature.
  • Development of a conceptual framework to define and guide the review of multilevel interventions (micro, meso, macro levels).
  • Data extraction and synthesis focused on intervention characteristics, targeted determinants, and reported outcomes, including proximal and equity outcomes.

Main Results:

  • 25 studies met inclusion criteria, with interventions categorized as targeted, environmental, or community-based.
  • Most interventions addressed 2 or 3 levels of influence, focusing on proximal outcomes like weight, physical activity, and diet.
  • A significant gap exists as only 32% reported metabolic risk changes, and none consistently measured population inequities or equity outcomes related to diabetes incidence.

Conclusions:

  • Multilevel diabetes prevention interventions have not consistently measured population equity outcomes.
  • There is a critical need to prioritize and consistently report equity outcomes in future research.
  • Future evaluations should emphasize the impact of interventions on disadvantaged populations and overall population inequities in diabetes incidence.