for the main comparison.

Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups
Population: ethnic minority groups with type 2 diabetes mellitus Settings: primary healthcare centres or hospital clinics Intervention: culturally appropriate health education (education tailored to the cultural or religious beliefs and linguistic skills of the community being approached, taking into account likely literacy skills) Comparison: conventional diabetes education
Outcomes	Culturally appropriate health education	Conventional diabetes education	Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
Complications of diabetes mellitus	See comment	See comment	Not estimable	See comment	See comment	2 studies provided limited data on complications (microalbuminuria, new cardiovascular events)
Health‐related quality of life Follow‐up: 3, 6 and 12 months	See comment	See comment	Not estimable	224 (3)	⊕⊕⊝⊝ lowa	Neutral effects on health‐related quality of life; only 3/7 studies reporting this outcome contained data that could be incorporated into meta‐analysis
All‐cause and specific mortality	See comment	See comment	Not estimable	See comment	See comment	Not investigated
Adverse events	See comment	See comment	Not estimable	See comment	See comment	There was a general lack of reporting of adverse events in most studies
(a) Self‐efficacy and empowerment Follow‐up: 3, 6 and 12 months (b) Participant satisfaction	(a) See comment (b) See comment	(a) See comment (b) See comment	(a) See comment (b) Not estimable	(a) 720 (6) at 3 months, 422 (4) at 6 months, 497 (2) at 12 months (b) See comment	(a) ⊕⊕⊝⊝ lowa (b) See comment	(a) Statistically significant difference at 6 months (SMD 0.49 (0.18 to 0.80)), but not at 3 and 12 months (b) Two studies had undertaken some form of participant satisfaction assessment but did not provide participant satisfaction scores
HbA1c [%] Follow‐up: 6 and 12 months	Mean HbA1c ranged across control groups from 7.8% to 12.2% at 6 months and 7.6% to 11.6% at 12 months	Mean HbA1c in the intervention groups was0.5% lower (0.7% to 0.4% lower) at 6 months and 0.2% lower (0.3% to 0.04% lower) at 12 months	‐	1972 (14) at 6 months 1966 (9) at 12 months	⊕⊕⊕⊕ high	‐
Health economics: cost‐effectiveness [QALY] Follow‐up: 6 months	Intervention vs control resulted in £28,933 per QALY gained			417 (1)	⊕⊕⊝⊝ lowb	Five studies provided rough estimates of costs ranging from $250 per participant over 6 weeks to $701 per participant over 2 years
*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; QALY: quality‐adjusted life years; RR: risk ratio; SMD: standardised mean difference.
GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

^aDowngraded by two levels because of inconsistency and risk of performance and detection bias.
 ^bDowngraded by two levels because of one study with only a few participants and short follow‐up, as well as risk of performance bias.