Objective: This scoping review will systematically map and describe evidence on cardiometabolic disease management in and for South Asian tribal (Indigenous) populations and identify key knowledge gaps to inform future studies and interventions. Introduction: South Asia is home to diverse tribal populations facing persistent health inequities due to geographic isolation, socioeconomic disadvantage, and limited access to formal health systems. Cardiometabolic diseases are increasingly reported in these communities, where care involves biomedical services and traditional healing practices. The literature on the management of these diseases in and for tribal populations is fragmented across diverse study designs, health systems, and population groups, with no prior scoping review. Eligibility criteria: Studies on the management of 1 or more cardiometabolic disease—including hypertension, diabetes, dyslipidemia, obesity, and cardiovascular diseases—in or for South Asian tribal populations will be considered. Any community or health care setting will be eligible, and all empirical study designs. Methods: This review will follow the JBI methodology for scoping reviews and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Fifteen databases will be comprehensively searched for published and gray literature, supplemented by Google Scholar searches, reference lists, and forward citation tracking. No date or language restrictions will be applied. Identified studies will be screened by 2 reviewers independently, and data extracted from included studies using a standardized tool. Extracted data will be analyzed using simple descriptive statistics and descriptive content analysis and presented using tables and figures.

BACKGROUND:Type 2 diabetes mellitus (T2DM) is prevalent in Nepal, with many seeking primary care through Ayurveda, a widely practiced traditional system. However, concerns exist about suboptimal care and variability in clinical practice among Ayurvedic practitioners. No evidence-based clinical practice guideline (EB-CPG) is available for managing T2DM. Therefore, an EB-CPG was developed, and a feasibility study was conducted to inform a future cluster randomized controlled trial (RCT) assessing whether EB-CPG improves T2DM management compared with usual practice. METHODS:A two-arm feasibility cluster RCT was conducted in Ayurveda centers. Centers were randomized (1:1) by an independent statistician. Adults with newly diagnosed, treatment-naïve T2DM and glycated hemoglobin (HbA1c) of 6.5%-< 9% were recruited. Data collectors and the analyst were blinded to group allocation. RESULTS:Fourteen Ayurveda centers were approached, all recruited (seven/group) and completed the study. One center withdrew and did not enroll participants. Of 151 potential participants, 121 (80%) were recruited (60 in intervention and 61 in control). Of those, 84% were followed up to 6 months (51/group). The median adherence score to EB-CPG among practitioners was 1-2 (partial to adequate adherence). The median (interquartile range) number of EB-CPG-recommended medicines not consumed by participants and days without consumption was 0 (0-10) and 0 (0-2.5), respectively. No serious adverse events occurred. Preliminary estimates suggest EB-CPG's beneficial effects on HbA1c, fasting plasma glucose, and health-related quality-of-life, though not statistically significant. CONCLUSION:This feasibility trial demonstrated successful recruitment, follow-up, and intervention adherence. A definitive trial is feasible to evaluate the intervention's effectiveness in T2DM management. TRIAL REGISTRATION NUMBER:ClinicalTrials.gov Identifier: NCT05259735; first posted on March 02, 2022.

Abstract Background/Aims Arthritis places a growing global burden on both physical and mental health. Systematic reviews suggest that yoga, an ancient mind-body discipline, shows promise in easing symptoms and improving well-being. Despite this potential, few people with arthritis take it up. No prior synthesis has explained what drives some patients to embrace yoga while others avoid it. Therefore, this systematic review aimed to address that gap by synthesising existing evidence to uncover the barriers and facilitators that shape yoga practice in arthritis care. Methods JBI methodological guidance for qualitative systematic reviews was followed. MEDLINE, Embase, CINAHL Plus, PsycInfo, AMED, and Web of Science were searched to identify published studies, and ProQuest Dissertations and Theses for unpublished studies. Databases were searched from inception to 07 November 2024 without language restrictions. Two reviewers independently conducted study screening, methodological quality assessment, and data extraction. Data were synthesised using a meta-aggregative approach. Results Of 1330 identified records, nine articles, representing eight studies, were included. All studies were conducted in high-income countries (the USA, UK, and New Zealand), with a majority of female participants. Methodological quality ranged from moderate to high; six studies met at least seven of the ten quality assessment criteria. A total of 112 findings were extracted from the articles and grouped into 20 categories based on similarity in meaning. These were formulated into five synthesised findings: (i) Yoga, arthritis, and the body: the anticipated and experienced impacts of yoga on physical well-being influenced yoga practice; (ii) Yoga, arthritis, and the mind: levels of motivation and perceived impact on mental well-being influenced yoga practice; (iii) Yoga, arthritis, and the mind-body impact: yoga’s mind-body benefits supported coping with arthritis and encouraged continued practice; (iv) Yoga, arthritis, and session accessibility and structure: factors related to session accessibility and structure influenced engagement with yoga; and (v) Yoga, arthritis, and the session environment: a supportive social environment in yoga sessions impacted yoga practice. Conclusion This systematic review synthesised a range of barriers and facilitators to yoga practice among people living with arthritis. People recognise yoga’s physical, mental, and mind-body benefits, yet barriers related to accessibility, session structure, and social environment often limit participation. Importantly, facilitators outweighed barriers, suggesting strong potential for yoga to be integrated into arthritis care. For clinicians, the next step may be to actively support safe, accessible, and culturally sensitive yoga options by signposting patients to credible arthritis-specific yoga programmes. For patient organisations, a next step might be to work with yoga providers to adapt sessions for physical limitations and to encourage social and peer support within group settings to boost engagement. Future clinical pathways could consider embedding yoga as a complementary option alongside conventional treatments. Disclosure I. Biswas: None. P. Egwumba: None. C. Evans: None. K. Kumar: None. S. Lewis: None. K. Chattopadhyay: None.

Background:Type 2 diabetes mellitus (T2DM) is common in Nepal, where many people seek primary care through Ayurveda, a widely practiced traditional medical system. However, concerns remain about variability in clinical practice and the quality of care provided by Ayurvedic practitioners. No evidence-based clinical practice guideline (EB-CPG) currently exists for managing T2DM in Ayurveda. To address this, an EB-CPG was developed, and a feasibility trial was conducted to inform a future definitive cluster randomized controlled trial evaluating whether the EB-CPG would improve T2DM management compared to usual clinical practice. Objectives:To explore the experiences and perspectives of Ayurvedic practitioners and patients regarding the two treatment groups (EB-CPG-based care versus usual clinical practice) and participation in the feasibility trial. Design:Constructivist qualitative study. Methods:Semistructured interviews were conducted with Ayurvedic practitioners and patients. Data were analyzed thematically using an inductive approach and the framework method. Results:A total of 41 Ayurvedic practitioners and patients were interviewed. Common themes identified across both groups included facilitators and challenges in the trial patient recruitment, challenges in usual clinical care, experiences with EB-CPG-based care (predominantly positive), ease and difficulties of monthly follow-ups, and pros and cons of patient diaries for assessing medication compliance. Practitioner-specific themes included the diverse populations they serve; patients' motivations for choosing Ayurveda over Western medicine; their motivations for trial participation; balancing clinical duties with the trial demands; confusion about trial roles and responsibilities; and other trial-related issues such as understanding processes and documentation, support and communication, coordination with data collectors, and finances and other resources. Conclusion:The EB-CPG-based approach for managing T2DM by Ayurvedic practitioners in Nepal was well-received and perceived as more beneficial than usual clinical practice. Trial experiences and perspectives were largely positive; however, several challenges related to trial conduct should be addressed in future studies, including the definitive cluster trial.

OBJECTIVE:This systematic review aimed to synthesize the content, structure, and delivery characteristics of effective yoga interventions in addition to standard medical treatment for rheumatoid arthritis (RA). METHODS:The Joanna Briggs Institute guidelines were followed. Seventeen databases were searched for randomized controlled trials (RCTs) assessing yoga's effectiveness in treating RA outcomes (disease activity score, pain, and function). Meta-analyses and narrative synthesis were conducted. RESULTS:Nine articles representing five RCTs were included and had low methodological quality scores. Yoga interventions, in addition to standard medical treatment, improved disease activity scores (standardized mean difference [SMD] -0.46, 95% confidence interval [CI] -0.73 to -0.18) and function (SMD -0.42, 95% CI -0.78 to -0.07) but did not effectively reduce pain (SMD -1.06, 95% CI -2.62 to 0.50) compared to standard medical treatment alone. All five RCTs found yoga's beneficial effects on one or more outcomes. All yoga interventions included center-based (supervised, group) sessions, and two included additional home-based (unsupervised, individual) sessions. All interventions incorporated 20 yogic poses (6 standing, 5 supine, 5 prone, and 4 seated), 7 breathing practices, and 4 meditation and relaxation practices. Two interventions offered RA-specific yogic pose modifications. Center-based sessions were delivered at least once weekly for 8 weeks' median duration and around 68 minutes per session. Home-based yoga was recommended thrice weekly for a 10-week mean duration and 40 minutes per session. CONCLUSION:Yoga might be useful in addition to standard medical treatment for RA. Given previous studies' methodological limitations, a high-quality RCT should be conducted based on our synthesized key features of effective yoga interventions.

This study explored yoga providers' clinical knowledge of arthritis, experiences of delivering yoga to people with arthritis, their perceived role in arthritis treatment, and perceived yoga training needs. Qualitative semi-structured interviews with 20 United Kingdom (UK)-based yoga providers were conducted. The interviews were digitally recorded, transcribed verbatim, and analysed thematically. The analysis generated eight themes. Yoga providers were generally aware of their attendees' health conditions and had clinical knowledge of arthritis through their yoga training. They were reasonably confident in delivering yoga to attendees with arthritis and felt that they had an important role in supporting these attendees. Gentle yoga practices were considered appropriate by the yoga providers, with a perception that a potential interplay between major components of yoga including yogic poses (asana), breathing practices (pranayama), and meditation (dhyana) and relaxation practices could help impart mind-body benefits in arthritis. Creating a safe and supportive environment in yoga sessions, being empathetic towards attendees' needs, and offering tailored modifications were perceived to be important for delivering yoga in arthritis treatment. Major system-level challenges to yoga delivery in arthritis treatment included the inadequate promotion of yoga, the unregulated nature of yoga delivery, and the absence of evidence-based arthritis-specific yoga training. Yoga providers felt they could play a key role in arthritis treatment in the UK, provided yoga is adequately promoted and made accessible to people with arthritis, yoga delivery is regulated, and arthritis-specific yoga training using the best available scientific evidence is made accessible to them.

INTRODUCTION:Non-communicable diseases (NCDs) are a leading cause of morbidity and mortality in the United Kingdom, placing significant pressure on the National Health Service (NHS). Despite the growing popularity of Ayurveda for managing NCDs, little is known about its use among people with these conditions in the United Kingdom. This study explored the experiences and perspectives of people with NCDs who use Ayurveda to manage their conditions in the United Kingdom. METHODS:Twenty qualitative semi-structured interviews were conducted with UK-based adults with NCDs. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. FINDINGS:Three key themes were identified. First, participants chose Ayurveda due to its alignment with personal values like natural, holistic healing and dissatisfaction with Western medicine, particularly side effects and impersonal care. Second, they reported positive experiences with Ayurvedic treatment, including personalised consultations, diverse treatment options and improved health outcomes. Third, participants highlighted challenges in sustaining Ayurvedic care, such as concerns over product safety, difficulty following complex regimens, limited medicine availability and financial barriers-especially since treatments are not covered by the NHS. CONCLUSION:People living with NCDs described Ayurveda as a more natural and philosophically congruent healing system, reflecting their cultural and personal perspectives. Despite structural and financial challenges, they considered it a relevant option for managing their conditions. These findings suggest that Ayurveda continues to hold significance as a complementary approach to NCD management in the United Kingdom.

The global burden of arthritis is high and increasing. Systematic reviews suggest that yoga, an ancient mind-body discipline, may help in arthritis treatment. This systematic review aimed to synthesise the barriers and facilitators to yoga practice in people with arthritis. JBI methodological guidance for qualitative systematic reviews was followed. MEDLINE, Embase, CINAHL Plus, PsycInfo, AMED, and Web of Science were searched to identify published studies, and ProQuest Dissertations and Theses for unpublished studies. Databases were searched until 07 November 2024, with no language restrictions. Study screening, assessment of methodological quality, and data extraction were completed independently by two reviewers. Data were synthesised using a meta-aggregative approach. Of 1330 identified records, nine articles, representing eight studies, were included in the review. All studies were conducted in high-income countries (the USA, UK, and New Zealand), with a majority of female participants. Methodological quality ranged from moderate to high; six of the eight studies met at least seven of the ten quality assessment criteria. 112 findings were extracted from the articles and grouped into 20 categories based on similarity in meaning. These were formulated into five synthesised findings: (i) Yoga, arthritis, and the body: the anticipated and experienced impacts of yoga on physical well-being influenced yoga practice; (ii) Yoga, arthritis, and the mind: levels of motivation and perceived impact on mental well-being influenced yoga practice; (iii) Yoga, arthritis, and the mind-body impact: yoga’s mind-body benefits supported coping with arthritis and encouraged continued practice; (iv) Yoga, arthritis, and session accessibility and structure: factors related to session accessibility and structure influenced engagement with yoga; and (v) Yoga, arthritis, and the session environment: a supportive social environment in yoga sessions impacted yoga practice. Each synthesised finding revealed a range of barriers and facilitators to yoga practice in people with arthritis. Within the included studies, there appeared to be more facilitators than barriers, suggesting that yoga could be a valuable addition to arthritis treatment. Future interventions to support yoga practice in this group should promote these facilitators and address the barriers to ensure successful implementation. PROSPERO registration number: CRD42023483350.

Background:Ayurveda, a traditional system of medicine, has gained recognition in the Organisation for Economic Cooperation and Development (OECD) countries as a complementary and alternative medicine for managing noncommunicable diseases (NCDs). Qualitative studies have been conducted in various OECD countries regarding the use of Ayurveda for NCD management. However, no qualitative systematic review has been conducted on this topic. Aim:This review aimed to synthesize the experiences, perceptions, and perspectives of patients with NCDs and Ayurvedic practitioners on the use of Ayurveda for NCD management in OECD countries. Methods:The JBI qualitative systematic review guidelines were followed. Several databases were searched to identify published and unpublished qualitative studies. Results:Of the 18,541 records identified, 9 studies met the eligibility criteria and were included in the review. Using the JBI checklist for qualitative research (10 criteria), the critical appraisal scores of the studies ranged from moderate to high quality. Patients turned to Ayurveda because of concerns about side effects and dissatisfaction with conventional Western treatments and were driven by the perceived gentleness and holistic qualities of Ayurveda. Complementing these patient insights, Ayurvedic practitioners emphasized that Ayurveda identifies and addresses the root causes of diseases rather than treating symptoms alone. Integration challenges, limited medication access, and regulatory constraints were identified as factors affecting Ayurveda's service delivery. Conclusions:Patients preferred Ayurveda because of its natural approach and fewer side effects, whereas Ayurvedic practitioners valued its holistic approach. However, its wider acceptance has been hampered by hurdles such as regulatory barriers and limited access to medicines. Strategies to overcome some of the barriers identified in this review as well as to promote the strengths discussed in this review may facilitate the effective use of Ayurveda to manage NCDs in OECD countries. Trial Registration: PROSPERO, Registration No. CRD42023397952.

Yoga, a mind-body discipline originating in the Indian subcontinent, might help relieve symptoms of rheumatoid arthritis (RA). This systematic review aimed to synthesise the content, structure, and delivery characteristics of effective yoga interventions for RA. The JBI methodology for systematic reviews of effectiveness were followed. Randomised controlled trials (RCTs) assessing the effectiveness of yoga interventions in treating one or more RA outcomes - disease activity score, pain and function - were included. 17 databases were searched from inception to 16 November 2023 to find published and unpublished studies. No language restrictions were applied. Random effects meta-analyses were conducted to identify effective yoga interventions that reduced disease activity scores and/or reduced pain, and/or improved function. Next, the effective interventions’ content, structure, and delivery characteristics were narratively synthesised. The certainty of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Of 2405 retrieved records, 9 articles representing 5 RCTs were included in the systematic review and meta-analysis and had low methodological quality scores. Compared to usual medical care (doctor appointments and standard medications for RA) and health education programmes, yoga as an adjuvant treatment improved disease activity scores (standardised mean difference (SMD) -0.46; 95% confidence interval (CI) -0.73 to -0.18) and function (-0.42; -0.78 to -0.07) but did not effectively reduce pain (-1.06; -2.62 to 0.50). Moderate-certainty evidence for disease activity score and function and very low-certainty evidence for pain were found using the GRADE approach. Overall, all 5 RCTs found beneficial effects of yoga interventions on one or more outcomes. The yoga interventions of all 5 RCTs included centre-based (supervised, group) sessions with 2 interventions including additional home-based (unsupervised, individual) sessions. All interventions included major components of yoga including 20 different yogic poses (asana; 6 standing, 5 supine, 5 prone, and 4 seated), 7 breathing practices (pranayama), and 4 meditation (dhyana) and relaxation practices. 4 interventions included all 3 major components. 2 interventions offered RA-specific yogic pose modifications using props (e.g., balls, blocks, belts, chairs, pillows, and blankets). Centre-based sessions were delivered at least once weekly for 8 weeks median duration and around 68 minutes per session. Home-based yoga was recommended thrice weekly for a 10-week mean duration and 40 minutes per session. Strategies were used to monitor and improve adherence to centre-based yoga practice - maintaining self-recorded diaries (1 intervention) and home practice - e.g., telephone call reminders and verbal discussion with yoga providers regarding experiences of home-based yoga (2 interventions). Long-term yoga practice was encouraged in 2 interventions. Considering the methodological limitations of previous RCTs, a high-quality RCT should be conducted to determine the effectiveness of yoga as an adjuvant treatment with standard medications for treating RA. I. Biswas: None. J. Kaur: None. F. Pearce: None. S. Lewis: None. K. Chattopadhyay: None.

Background: Self-monitoring of blood glucose (SMBG) is recommended in clinical practice guidelines, including those in China, as part of patient education, self-management, and empowerment. With technological advancements, telecommunication technologies are now used for telemonitoring in health care. Mobile apps have become a practical tool for SMBG among patients with type 2 diabetes mellitus (T2DM). However, the long-term effectiveness of this approach in real-world practice requires further exploration. Objective: The study aims to determine the effectiveness of mobile app-assisted SMBG in improving glycemic control in patients with T2DM at 12 months, in addition to standard care, in Ningbo, China. Methods: In this retrospective cohort study, adults with T2DM who registered at the National Metabolic Management Center, Ningbo, for the first time between September 1, 2019, and June 30, 2022, and received standardized diabetes management were included. The study compared 2 groups: those who opted for mobile app-assisted SMBG and those who did not. Propensity score matching matched the mobile app-assisted SMBG group with the control group based on similar baseline characteristics. Glycemic control-related outcomes were compared at 12-month follow-up. Linear and logistic regression models were used to estimate mean differences and odds ratios (ORs) along with 95% CIs, respectively, and adjustments were made for baseline characteristics. Results: A total of 160 patients (80 in each group) were included in the study. In the mobile app-assisted SMBG group, the median (IQR) frequency of blood glucose monitoring was 0 (0-2) times per week, with 28% (22/80) monitoring their blood glucose at least twice per week, and the app usage frequency was 1 (0-3) time per week, with 40% (32/80) logging in at least twice per week. There were no statistically significant differences observed between the mobile app-assisted SMBG group and the control group in glycemic control outcomes at 12 months. Specifically, the results showed no significant difference in (1) fasting blood glucose and glycosylated hemoglobin levels (mean difference-0.17 mmol/L, 95% CI-0.85 to 0.51 mmol/L; P=.62 and-0.12%, 95% CI-0.58% to 0.33%; P=.59, respectively) and (2) the proportion of patients achieving or maintaining fasting blood glucose at <7 mmol/L and glycosylated hemoglobin at <7% (OR 0.89, 95% CI 0.46-1.73; P=.74 and OR 0.91, 95% CI 0.44-1.88; P=.79, respectively). Conclusions: In a real-world cohort of patients with T2DM in Ningbo, China, mobile app-assisted SMBG did not lead to statistically significant improvements in glycemic control at 12 months. This suggests that in a well-resourced setting, standard care alone may be relatively effective. However, opportunities for further improvement remain. The lack of observed benefit may be due to process-related issues, such as suboptimal engagement with the intervention. Addressing these challenges should be a focus of future research.

The editorial highlights the fact that there is limited communication between healthcare providers and patients about complementary and integrative medicine (TCI) like Ayurveda. To address this, healthcare professionals need better education on Ayurveda. Additionally, international collaborations can enhance research and credible information, ensuring safe and effective patient care.

BackgroundMultimorbidity among older adults is a growing concern in India. Multimorbidity is defined as the coexistence of two or more chronic health conditions in an individual. Primary studies have been conducted on risk factors of multimorbidity in India, but no systematic review has been conducted on this topic. This systematic review aimed to synthesize the existing evidence on risk factors of multimorbidity among older adults in India.MethodsThe JBI and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Several databases were searched for published and unpublished studies until August 03, 2022. The screening of titles and abstracts and full texts, data extraction, and quality assessment were conducted by two independent reviewers. Any disagreements were resolved through discussion or by involving a third reviewer. Data synthesis was conducted using narrative synthesis and random effects meta-analysis, where appropriate.ResultsOut of 8781 records identified from the literature search, 16 and 15 studies were included in the systematic review and meta-analysis, respectively. All included studies were cross-sectional, and 10 met a critical appraisal score of more than 70%. Broadly, sociodemographic, lifestyle, and health conditions-related factors were explored in these studies. The pooled odds of multimorbidity were higher in people aged >= 70 years compared to 60-69 years (odds ratio (OR) 1.51; 95% confidence interval (CI) 1.20-1.91), females compared to males (1.38; 1.09-1.75), single, divorced, separated, and widowed compared to married (1.29; 1.11-1.49), economically dependent compared to economically independent (1.54; 1.21-1.97), and smokers compared to non-smokers (1.33; 1.16-1.52) and were lower in working compared to not working (0.51; 0.36-0.72).ConclusionThis systematic review and meta-analysis provided a comprehensive picture of the problem by synthesizing the existing evidence on risk factors of multimorbidity among older adults in India. These synthesized sociodemographic and lifestyle factors should be taken into consideration when developing health interventions for addressing multimorbidity among older adults in India.

OBJECTIVE:The objective of this review was to assess and synthesize evidence on the effectiveness and safety of self-management interventions for improving glycemic control and health-related quality of life among adults with type 2 diabetes mellitus (T2DM) in sub-Saharan Africa. INTRODUCTION:There has been a rapid increase in the prevalence of T2DM in sub-Saharan Africa. Lifestyle-related risk factors require self-management strategies, and these must be tailored to the context. Several randomized controlled trials (RCTs) evaluating T2DM self-management interventions in sub-Saharan Africa have been conducted. INCLUSION CRITERIA:This systematic review included RCTs assessing the effectiveness and safety of self-management interventions among adults with T2DM in sub-Saharan Africa, where the self-management intervention matched at least 1 category of the Practical Reviews in Self-Management Support (PRISMS) for long-term conditions taxonomy. METHODS:The following databases were searched from inception until January 14, 2023: MEDLINE (Ovid), PubMed, Embase (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Directory of Open Access Journals, EThOS, and ProQuest Dissertations and Theses (ProQuest). Global Health (EBSCOhost) was searched from inception until June 8, 2021. OpenGrey was searched from inception until its archive date of December 1, 2020. Two independent reviewers conducted title and abstract screening, full-text screening, data extraction, and critical appraisal. Disagreements were resolved through discussion or with a third reviewer. Data synthesis was conducted narratively, followed by meta-analysis where feasible. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach for assessing the certainty of evidence was applied. RESULTS:From 2699 records identified, 18 RCTs were included in the systematic review and 14 in the meta-analysis. Interventions included broad self-management education programs, peer support, exercise interventions with education, nutrition education, educational text messaging, and blood glucose self-monitoring support. Only 4 studies received a "yes" response for more than half of the criteria in the standardized JBI critical appraisal tool for RCTs. Compared to the control, self-management interventions did not significantly reduce glycated hemoglobin (HbA1c) levels at 3 months (302 participants, mean difference [MD] -6.0 mmol/mol, 95% CI -17.5, 5.4; very low certainty on GRADE assessment) or 12 months (1504 participants, MD -3.7 mmol/mol, 95% CI -8.2, 0.7; moderate certainty on GRADE assessment). HbA1c was significantly reduced at 6 months (671 participants, MD -8.1 mmol/mol, 95% CI -10.7, -5.4; low certainty on GRADE assessment). Four studies assessed health-related quality of life, but only 1 demonstrated an improvement (2205 participants). Three studies reported no adverse events in relation to the trial interventions (1217 participants), and adverse events were not reported in the remainder of studies. There did not appear to be clinically significant effects on body mass index, lipid profile, or systolic or diastolic blood pressure. The evidence was mixed for weight and waist circumference. CONCLUSIONS:Self-management interventions for adults living with T2DM in sub-Saharan Africa may produce a clinically significant improvement in glycemic control at 6 months, but this may wane in the long term. There was not convincing evidence to indicate a benefit of these interventions on health-related quality of life, but reporting on this outcome measure was limited. There were insufficient data on adverse events to be able to draw conclusions. REVIEW REGISTRATION:PROSPERO CRD42021237506.

EDITORIAL article Front. Pharmacol., 15 January 2024Sec. Ethnopharmacology Volume 14 - 2023 | https://doi.org/10.3389/fphar.2023.1353483

This systematic review aimed to synthesise the content, structure, and delivery characteristics of effective yoga interventions for managing osteoarthritis symptoms, including joint pain and joint function. JBI guidelines were followed. 17 databases were searched for randomised controlled trials (RCTs) assessing yoga's effectiveness on osteoarthritis symptoms. Meta-analyses and a narrative synthesis were conducted to address the objective. The systematic review and meta-analysis included 18 and 16 articles (representing 16 and 14 RCTs), respectively. Overall, the included studies had low methodological quality scores. 10 of 14 yoga interventions effectively reduced pain (standardised mean difference (SMD) - 0.70; 95% confidence interval (CI) - 1.08, - 0.32) and/or improved function (- 0.40; - 0.75, - 0.04). Notably, 8 effective interventions had centre-based (supervised, group) sessions, and 6 included additional home-based (unsupervised, individual) sessions. Effective interventions included 34 yogic poses (12 sitting, 10 standing, 8 supine, 4 prone), 8 breathing practices, and 3 meditation and relaxation practices. 8 interventions included yogic poses, and 7 also incorporated breathing practices and/or meditation and relaxation practices. 4 interventions included yogic pose modifications for osteoarthritis. The median duration of centre-based sessions was 8 weeks and each session was around 53 min, mostly delivered once a week. The median duration of home-based sessions was 10 weeks and each session was 30 min, usually instructed to practice 4 times a week. Given previous studies' limitations, a high-quality long-term RCT should be conducted using synthesised findings of previous effective yoga interventions.

INTRODUCTION:Over the last few decades, India has witnessed an increase in the number of people with type 2 diabetes mellitus (T2DM). Consequently, several clinical practice guidelines (CPGs) have been developed to assist western and traditional Indian medicine practitioners in managing this disease. This systematic review aimed to evaluate and synthesize the content and quality of these CPGs. METHODS:Several databases and sources were searched from inception to May 2022, to identify CPGs for managing adults with T2DM in India. The screening of titles and abstracts and full texts, data extraction and quality assessment were conducted by two independent reviewers. Any disagreements were resolved through discussion or by involving a third reviewer. A data extraction tool from a previous study was adapted to extract the content of the included CPGs, and the Appraisal of Guidelines for Research and Evaluation II tool was used to assess the quality of the included CPGs. A narrative synthesis was conducted. RESULTS:Of 3350 records identified, 11 were retrieved for full-text screening and five CPGs were included in this systematic review-three focused on traditional Indian medicine (Ayurveda) and two focused on western medicine. These two western medicine CPGs contained comprehensive recommendations for managing T2DM but only one of these, the Research Society for the Study of Diabetes in India/Endocrine Society of India (RSSDI/ESI) CPG, was of high quality. CONCLUSIONS:Only one CPG can be recommended for managing T2DM by western medicine practitioners in India. Future CPGs, especially for traditional Indian medicine practitioners, should be developed and updated using the standard CPG manuals and quality appraisal tools. REGISTRATION:PROSPERO (CRD42021279499).