Specialist-led interventions to support equity-deserving populations with diabetes: A scoping review of the literature

Table 1 Description of included studies

Ref.	Design	Participants	Follow-up	Results	Facilitators	Location	Intervention	Outcomes	Barriers
Gunasekaran et al[35]	United States	QI	Tele-health	8749 with DM (underserved)	12 months	Care utilization, HbA1c	Patients seen increased by 356%. HbA1c decreased from 9.4% to 8.9%	Clinic buy-in	COVID disruptions
Huckfeldt et al[42]	United States	QI	Multidisciplinary care	> 4000 with T2D (low SES)	2 years	HbA1c, LDL	Site 1: HbA1c decreased up to 4.5%; LDL decreased by 12-27 mg/dL. Site 2: HbA1c decreased by 1.5%; LDL decreased by 17 mg/dL	Integrated care	Resource intensity
Kahkoska et al[41]	United States	Cohort (prospective)	Multidisciplinary care, community support	29 with T2D (uninsured)	12 months	HbA1c	HbA1c decreased from 9.7% to 9.2%	Patient-engagement	Attendance
Hassaballa et al[52]	United States	QI	Patient education, community support	200 with T2D (low income, minority)	12 months	Care utilization	Percent with zero ED visits decreased from 44.5% to 78.5%	Community engagement	Food insecurity
Majumdar et al[40]	Canada	Cohort (prospective)	Multidisciplinary care	379 with DM (rural)	6 months	BP, cholesterol, HbA1c (composite)	44% vs 37% in control group achieved 10% improvement	Specialist involvement	Recruitment challenges
Ehrhardt et al[22]	Intl	QI	Provider education	> 40000 care providers	13 years	Provider capacity, patient self-efficacy	Improved well being, health behaviours, confidence, symptoms	Adaptability	Connectivity
Paul et al[25]	United States	Cross-sectional	Provider education	867 with DM (hispanic majority)	12 months	Care utilization	Delays in care decreased from 30% to 14%. ≥ 4 visits/year increased from 55% to 72%. HbA1c monitoring increased to 91%	Specialist involvement	Low follow-up
Walker et al[21]	United States	Cohort (prospective)	Patient education	582 with DM (minority)	12 months	HbA1c	HbA1c decreased from 8.7% to 8.4%	Compensation	Not reported
Addala et al[23]	United States	QI	Provider education	116 care providers	-	Provider confidence	Confidence in T1D improved from 43.8% to 68.8%. Confidence in insulin improved from 62.8% to 84.3%	Targeted education	Policy burden
Berry et al[24]	United States	QI	Provider education	861 with DM (underserved)	12 months	Care utilization	≥ 4 visits/year in 69% vs 58% in control group. Eye exam in 69% vs 87% usual care	Robust sample size	Not reported
Doherty et al[53]	United Kingdom	QI	Multidisciplinary care	119 with DM (socially deprived)	12 months	Metabolic, mental health	HbA1c decreased by 3%. Cholesterol decreased by 0.4 mmol/L	Integrated care	Complexity
Mayer et al[38]	United States	Cohort (retrospective)	Community support (finances)	38247 with DM (minority, comorbid)	12 months	Care utilization	4.6 more outpatient visits and follow up within 7 days of acute care encounters	Rigorous methods	Contact barriers
Mathias et al[54]	United States	QI	Patient education	1357 with T1D (minority)	3 years	Technology	CGM use increased from 15% to 69%	Equity focus	COVID disruptions
Ryan et al[39]	United States	Cross-sectional	Community support (finances)	250 with T2D (uninsured)	12 months	HbA1c, adherence	HbA1c decreased from 8.4% to 7.9%	Removal of costs	Health literacy
Steenkamp et al[30]	United States	QI	Patient education	97 with T1D (minority)	6 months	Technology	AID initiation increased from 13.5% to 64%. HbA1c decreased from 8.7% to 7.8%	Care coordinator	Lack of advisory support
Caruso et al[55]	United States	QI	Patient and provider education	283 with DM (elderly)	39 months	Self-monitoring	HbA1c testing increased from 59% to 78%. HbA1c decreased from 7.9% to 7.3%. Foot exams increased from 26% to 57%	Continuous feedback	Resource constraints
Carrasquillo et al[37]	United States	RCT	Community outreach	300 with T2D (Latino)	12 months	HbA1c	HbA1c 0.51% lower in intervention vs control	Cultural alignment	Attendance
Lynch et al[29]	United States	RCT	Patient education	211 with T2D (Black)	18 months	Diet, HbA1c	HbA1c declined by 0.76% vs 0.21% in control, but not persistent to end of follow up	Cultural tailoring	Poverty
Rosal et al[28]	United States	RCT	Patient education	89 with DM (low income Black women)	8 weeks	HbA1c	HbA1c declined from 9.4% to 8.9% with F2F vs 9.6% to 9.3% with virtual education	Use of technology	High cost
Chambers et al[51]	United States	QI	Patient education	31524 with pre DM (non-English, low income)	12 months	Weight	Weight decreased by 3.25%	Use of technology	Retention
Cho et al[44]	Korea	RCT	Multidisciplinary care	71 with T2DM (rural)	12 weeks	HbA1c, cholesterol	HbA1c decreased from 8.0% to 7.5% vs 8% to 7.8% in control. Total cholesteral decreased from 5.0 mmol/L to 4.8 mmol/L vs 5.0 mmol/L to 5.1 mmol/L in control	Patient engagement	Internet access
Nikkanen et al[46]	Finland	Cohort (prospective)	Multidisciplinary care	101 with DM (rural)	10-14 months	HbA1c, LDL, BP	HbA1c decreased from 8.0% to 7.6%. LDL decreased from 3.3 mmol/L to 2.7 mmol/L. SBP decreased from 146 mmHg to 140 mmHg	Nurse support	High cost
Crowley et al[45]	United States	RCT	Tele-health/multidisciplinary care	200 with DM (underserved)	12 months	HbA1c	HbA1c decreased from 10.2% to 8.6% vs 10.2% to 9.2% in control	Multi-component design	Needed infrastructure
Toledo et al[47]	United States	Cohort (prospective)	Multidisciplinary care	25 with DM (rural underserved)	18 months	HbA1c	HbA1c decreased from 9.6% to 8.5%	Nurse support	Transportation barriers
Gunawan et al[27]	United States	QI	Tele-health	266 with DM (underinsured)	6 months	HbA1c, care utilization	HbA1c decreased by 10.1% to 9.3%	Integrated care	Retention
Karimi et al[33]	Australia	Qualitative	Patient education	60 with T2D (low income)	12 weeks	Diet	Healthy eating improved by 52%	User-friendly design	Access barriers
Fischer et al[32]	United States	Cohort (prospective)	Patient education	183 with pre DM (non-English, low income)	12 months	Weight	Weight decreased by 2.6 lb vs 0.6 lb in control. HbA1c decreased by 0.09% vs +0.19% control. SBP increased by 0.35 vs +6.4 mmHg in control	Low cost	Adherence
Fortmann et al[31]	United States	RCT	Patient education	126 with T2D (Hispanic)	6 months	HbA1c, LDL, weight, BP	HbA1c decreased by 9.4% to 8.7% vs 9.5% to 9.4% in control to month 3. No differences in LDL, weight, BP	Cultural tailoring	Communications

F2F: Face to face; V: Virtual; SES: Socio-economic status; CGM: Continuous glucose monitor; RCT: Randomized controlled trial; QI: Quality improvement; SBP: Systolic blood pressure; SMBG: Self-monitoring blood glucose; DM: Diabetes mellitus; T2D: Type 2 diabetes; T2DM: Type 2 diabetes mellitus; HbA1c: Glycated hemoglobin; LDL: Low-density lipoprotein; BP: Blood pressure; T1D: Type 1 diabetes; COVID: Coronavirus disease 2019; ED: Emergency department.