Understanding Gaps in Hypertension and Diabetes Care Cascade: A Systematic Scoping Review.

BACKGROUND

Hypertension and diabetes are global health challenges requiring effective management to mitigate their considerable burden. The key to successful management of hypertension and diabetes requires the completion of a sequence of stages, collectively termed the care cascade.

OBJECTIVE

This scoping review aimed to describe the characteristics of studies on hypertension and diabetes care cascade and identify potential interventions as well as factors that impact each stage of the care cascade.

METHODS

The method of this scoping review is guided by Arksey and O'Malley's framework. We systematically searched Medline, Embase and Web of Science using terms pertinent to hypertension, diabetes and specific stages of the care cascade. Articles published after 2011 and included all studies that described the completion of at least one stage of the care cascade of hypertension and diabetes were included in this scoping review. Study selection was independently performed by two paired authors. Descriptive statistics were used to elucidate key patterns and trends. Inductive content analysis was performed to generate themes regarding barriers and facilitators to improving the care cascade in hypertension and diabetes management.

RESULTS

A total of 128 studies were included, with 42% conducted in high-income countries. Of them, 47 (36.7%) focused on hypertension care while 63 (49.2%) on diabetes, and only 18 (14.1%) articles reported on the care of both diseases. The majority (75%) were observational in design. Cascade stages documented in the literature were awareness, screening, diagnosis, linked to care, treatment, adherence to medication and control. Most studies focus on the stages of treatment and control while a relative paucity of studies examine the stages before treatment initiation (59% vs. 41%). A wide spectrum of interventions aimed at enhancing hypertension and diabetes care cascade were identified. The analysis unveiled a multitude of individual-level and system-level factors influencing the successful completion of cascade sequence in both high-income and low and middle-income settings.

CONCLUSIONS

This review offers a comprehensive understanding of hypertension and diabetes management, emphasising the pivotal factors that impact each stage of care. Future research should focus on upstream cascade stages and context-specific interventions to optimise patient retention and care outcomes.

CLINICALTRIAL

Not applicable.