Interventions to improve diabetes care and self-management for individuals experiencing homelessness: a scoping review with systematic search of qualitative and quantitative literature.

Abstract

Aims/hypothesis: Optimal diabetes management for people experiencing homelessness can be a challenge. Our aim was to summarise the existing literature on, highlight emerging evidence for and identify gaps in diabetes care for people experiencing homelessness.

Methods: We undertook a comprehensive and systematic search of 11 databases of published academic literature up to 24 September 2024. Only English and French studies were included. We used defined search and selection criteria to identify interventions or recommendations targeted towards diabetes care in people experiencing homelessness. We also conducted an extensive grey-literature search. Articles were screened at the abstract and full-text stages by two reviewers. We conducted descriptive analysis of the included studies.

Results: In total, 2367 records were identified in the initial search of the published literature (1182 after de-duplication), of which 75 met the criteria for inclusion. In addition, 194 records from the grey-literature sources met the criteria for inclusion, yielding a total of 269 documents included in the review. Most interventions were conducted in the USA (n=186) and were simple programme descriptions (n=173). Sixteen intervention categories were identified; the most common included mobile clinics, street medicine and outreach (n=68), multidisciplinary care (n=35), recommendations for providers (n=29) and foot care/assessment programmes (n=31). Of the 51 quantitative studies, 11 examined the effects of an intervention on HbA_1c, with seven showing reductions in HbA_1c, although these observations were statistically significant in only three studies. Risk of bias assessment of the quantitative studies revealed an overall high risk of bias, mainly secondary to attrition. Fifteen qualitative studies emphasised the need for specialised diabetes care for people experiencing homelessness, including the use of multidisciplinary teams to provide diabetes care and longer appointment times with health professionals.

Conclusions/interpretation: A broad spectrum of interventions have been implemented with the goal of improving diabetes care in people experiencing homelessness. There is an ongoing need for more structured evaluations of programmes that provide care for this population.