Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control.

OBJECTIVE To evaluate the efficacy of self-management education on GHb in adults with type 2 diabetes. RESEARCH DESIGN AND METHODS We searched for English language trials in Medline (1980-1999), Cinahl (1982-1999), and the Educational Resources Information Center database (ERIC) (1980-1999), and we manually searched review articles, journals with highest topic relevance, and reference lists of included articles. Studies were included if they were randomized controlled trials that were published in the English language, tested the effect of self-management education on adults with type 2 diabetes, and reported extractable data on the effect of treatment on GHb. A total of 31 studies of 463 initially identified articles met selection criteria. We computed net change in GHb, stratified by follow-up interval, tested for trial heterogeneity, and calculated pooled effects sizes using random effects models. We examined the effect of baseline GHb, follow-up interval, and intervention characteristics on GHb. RESULTS On average, the intervention decreased GHb by 0.76% (95% CI 0.34-1.18) more than the control group at immediate follow-up; by 0.26% (0.21% increase - 0.73% decrease) at 1-3 months of follow-up; and by 0.26% (0.05-0.48) at > or = 4 months of follow-up. GHb decreased more with additional contact time between participant and educator; a decrease of 1% was noted for every additional 23.6 h (13.3-105.4) of contact. CONCLUSIONS Self-management education improves GHb levels at immediate follow-up, and increased contact time increases the effect. The benefit declines 1-3 months after the intervention ceases, however, suggesting that learned behaviors change over time. Further research is needed to develop interventions effective in maintaining long-term glycemic control.

[1]  Warszawski Uniwersytet Medyczny,et al.  Diabetes care , 2019, Health at a Glance.

[2]  M. Uusitupa,et al.  Efficacy of dietary instructions in newly diagnosed non-insulin-dependent diabetic patients. Comparison of two different patient education regimens. , 2009, Acta medica Scandinavica.

[3]  S. Norris,et al.  Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. , 2001, Diabetes care.

[4]  M. Engelgau,et al.  Diabetes trends in the U.S.: 1990-1998. , 2000, Diabetes care.

[5]  A R Jadad,et al.  What contributions do languages other than English make on the results of meta-analyses? , 2000, Journal of clinical epidemiology.

[6]  R. Holman,et al.  Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study , 2000, BMJ : British Medical Journal.

[7]  J. Boucher,et al.  National standards for diabetes self-management education. Task Force to Review and Revise the National Standards for Diabetes Self-Management Education Programs. , 2000, Diabetes care.

[8]  M. Berger,et al.  Randomized controlled trials remain fundamental to clinical decision making in Type II diabetes mellitus: a comment to the debate on randomized controlled trials , 2000, Diabetologia.

[9]  R. Glasgow,et al.  In diabetes care, moving from compliance to adherence is not enough. Something entirely different is needed. , 1999, Diabetes care.

[10]  R. Glasgow,et al.  Evaluating the public health impact of health promotion interventions: the RE-AIM framework. , 1999, American journal of public health.

[11]  L. Harvill,et al.  Improved control of type 2 diabetes mellitus: a practical education/behavior modification program in a primary care clinic. , 1999, Southern medical journal.

[12]  C. Hanis,et al.  Culturally Competent Diabetes Education for Mexican Americans: The Starr County Study , 1999, The Diabetes educator.

[13]  K. Flegal,et al.  Racial and ethnic differences in glycemic control of adults with type 2 diabetes. , 1999, Diabetes care.

[14]  R. Holman,et al.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. , 1998 .

[15]  H. King,et al.  Global Burden of Diabetes, 1995–2025: Prevalence, numerical estimates, and projections , 1998, Diabetes Care.

[16]  Uk-Prospective-Diabetes-Study-Group.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) , 1998, The Lancet.

[17]  J. Pugh,et al.  Patient Choice in Diabetes Education Curriculum: Nutritional versus standard content for type 2 diabetes , 1998, Diabetes Care.

[18]  Stella M. Yu.  Healthy People 2010 , 1998, Maternal and Child Health Journal.

[19]  N. Ray,et al.  Economic Consequences of Diabetes Mellitus in the U.S. in 1997 , 1998, Diabetes Care.

[20]  J. Mann,et al.  Lifestyle intervention in people with insulin-dependent diabetes mellitus (IDDM) , 1997, European Journal of Clinical Nutrition.

[21]  S. Kumanyika,et al.  A Randomized Controlled Trial of Weight Reduction and Exercise for Diabetes Management in Older African-American Subjects , 1997, Diabetes Care.

[22]  C. Counsell,et al.  Formulating Questions and Locating Primary Studies for Inclusion in Systematic Reviews , 1997, Annals of Internal Medicine.

[23]  Jesse A Berlin,et al.  Does blinding of readers affect the results of meta-analyses? , 1997, The Lancet.

[24]  I Olkin,et al.  Comparison of effect estimates from a meta-analysis of summary data from published studies and from a meta-analysis using individual patient data for ovarian cancer studies. , 1997, American journal of epidemiology.

[25]  K. Hawthorne,et al.  One-to-one teaching with pictures--flashcard health education for British Asians with diabetes. , 1997, The British journal of general practice : the journal of the Royal College of General Practitioners.

[26]  Cindy Farquhar,et al.  3 The Cochrane Library , 1996 .

[27]  M. Uusitupa.  Early lifestyle intervention in patients with non-insulin-dependent diabetes mellitus and impaired glucose tolerance. , 1996, Annals of medicine.

[28]  R. Sanson-Fisher,et al.  The Relative Effectiveness of Educational and Behavioral Instruction Programs for Patients With NIDDM: A Randomized Trial , 1996, The Diabetes educator.

[29]  R. Glasgow,et al.  A brief office-based intervention to facilitate diabetes dietary self-management. , 1995, Health education research.

[30]  R. Bergenstal,et al.  Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin-dependent diabetes mellitus: a randomized, controlled clinical trial. , 1995, Journal of the American Dietetic Association.

[31]  S. Clement,et al.  Diabetes Self-Management Education , 1995, Diabetes Care.

[32]  M. Funnell,et al.  Patient Empowerment: Results of a randomized controlled trial , 1995, Diabetes Care.

[33]  M. Clarke,et al.  Identifying relevant studies for systematic reviews , 1995, BMJ.

[34]  National Standards for Diabetes Self-Management Education Programs , 1995, Diabetes Care.

[35]  M. Funnell,et al.  National Standards for Diabetes Self-Management Education Programs , 1995, Diabetes Care.

[36]  A. Mason,et al.  A Comparison of Learning Activity Packages and Classroom Instruction for Diet Management of Patients with Non-Insulin-Dependent Diabetes Mellitus , 1994, The Diabetes educator.

[37]  K. Dickersin,et al.  Systematic Reviews: Identifying relevant studies for systematic reviews , 1994 .

[38]  Frederick Mosteller,et al.  Guidelines for Meta-analyses Evaluating Diagnostic Tests , 1994, Annals of Internal Medicine.

[39]  B. Marcus,et al.  Evaluation of relapse prevention and reinforcement interventions to promote exercise adherence in sedentary females. , 1993, Research quarterly for exercise and sport.

[40]  S. Genuth,et al.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. , 1993, The New England journal of medicine.

[41]  D. Ronis,et al.  Behavioral Analysis and Behavioral Strategies to Improve Self-Management of Type II Diabetes , 1993, Clinical nursing research.

[42]  M. Uusitupa,et al.  The maintenance of improved metabolic control after intensified diet therapy in recent type 2 diabetes. , 1993, Diabetes research and clinical practice.

[43]  K. Tu,et al.  Diabetes Self-Care Knowledge, Behaviors, and Metabolic Control of Older Adults — The Effect of a Posteducational Follow-up Program , 1993, The Diabetes educator.

[44]  S. Brown.  Meta-analysis of diabetes patient education research: variations in intervention effects across studies. , 1992, Research in nursing & health.

[45]  J Wylie-Rosett,et al.  Metabolic Impact of Education in NIDDM , 1992, Diabetes Care.

[46]  M. Hendryx,et al.  Diabetes Support Groups Improve Health Care of Older Diabetic Patients , 1992, Journal of the American Geriatrics Society.

[47]  P. Lewinsohn,et al.  Improving self-care among older patients with type II diabetes: the "Sixty Something..." Study. , 1992, Patient education and counseling.

[48]  H. Farreny,et al.  Telematic expert system Diabeto: New Tool for Diet Self-Monitoring for Diabetic Patients , 1992, Diabetes Care.

[49]  D. Goldstein,et al.  Interlaboratory comparison of glycohemoglobin results: College of American Pathologists Survey data. , 1991, Clinical chemistry.

[50]  G. Kok,et al.  Randomized Controlled Multicentre Evaluation of an Education Programme for Insulin‐treated Diabetic Patients: Effects on Metabolic Control, Quality of Life, and Costs of Therapy , 1991, Diabetic medicine : a journal of the British Diabetic Association.

[51]  M. Funnell,et al.  Empowerment: An Idea Whose Time Has Come in Diabetes Education , 1991, The Diabetes educator.

[52]  S A Brown,et al.  Studies of educational interventions and outcomes in diabetic adults: a meta-analysis revisited. , 1990, Patient education and counseling.

[53]  K. Mann,et al.  Follow-up Intervention: Its Effect on Compliance Behavior to a Diabetes Regimen , 1990, The Diabetes educator.

[54]  Adriaan Visser,et al.  Attitude Behaviour Theories and Diabetes Education Programmes , 1989 .

[55]  L. Epstein,et al.  Self-regulation in the treatment of type II diabetes , 1988 .

[56]  R. Tattersall,et al.  Group Education for Obese Patients with Type 2 Diabetes: Greater Success at Less Cost , 1988, Diabetic medicine : a journal of the British Diabetic Association.

[57]  Sharon A. Brown.  Effects of Educational Interventions In Diabetes Care: A Meta‐Analysis of Findings , 1988, Nursing research.

[58]  I. Raz,et al.  Influence of Small-Group Education Sessions on Glucose Homeostasis in NIDDM , 1988, Diabetes Care.

[59]  C. Pratt,et al.  The impact of diabetes education and peer support upon weight and glycemic control of elderly persons with noninsulin dependent diabetes mellitus (NIDDM). , 1987, American journal of public health.

[60]  W. Karmally,et al.  Randomized, Controlled Trial of Diabetic Patient Education: Improved Knowledge Without Improved Metabolic Status , 1987, Diabetes Care.

[61]  L. Epstein,et al.  Does self-monitoring of blood glucose levels improve dietary compliance for obese patients with type II diabetes? , 1986, The American journal of medicine.

[62]  M. Falkenberg,et al.  Problem oriented participatory education in the guidance of adults with non-insulin-treated type-II diabetes mellitus. , 1986, Scandinavian journal of primary health care.

[63]  K. Meadows,et al.  Effect of Computer-Based Learning on Diabetes Knowledge and Control , 1986, Diabetes Care.

[64]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[65]  C. A. Nugent,et al.  Management of Obese Patients With Diabetes Mellitus: Comparison of Advice Education With Group Management , 1986, Diabetes Care.

[66]  E. Bartlett,et al.  Historical glimpses of patient education in the United States. , 1986, Patient education and counseling.

[67]  N. Fineberg,et al.  The Diabetes Education Study: A Controlled Trial of the Effects of Diabetes Patient Education , 1986, Diabetes Care.

[68]  M. Duffy,et al.  A research appraisal checklist for evaluating nursing research reports. , 1985, Nursing & health care : official publication of the National League for Nursing.

[69]  R. Kaplan,et al.  Prospective Evaluation of HDL Cholesterol Changes After Diet and Physical Conditioning Programs for Patients with Type II Diabetes Mellitus , 1985, Diabetes Care.

[70]  A. Feinstein,et al.  Clinical Epidemiology: The Architecture of Clinical Research. , 1987 .

[71]  L. Epstein,et al.  Behavior change, weight loss, and physiological improvements in type II diabetic patients. , 1985, Journal of consulting and clinical psychology.

[72]  J. Stafford,et al.  The Effectiveness of Diabetes Education for Non-Insulin-Dependent Diabetic Persons , 1984, The Diabetes educator.

[73]  R. Tattersall,et al.  Influence of imaginative teaching of diet on compliance and metabolic control in insulin dependent diabetes. , 1983, British medical journal.

[74]  T. M. Hayes,et al.  A randomised controlled trial of the effect of low fat diet advice on dietary response in insulin independent diabetic women , 1981, Diabetologia.

[75]  J F Sallis,et al.  Behavioral science research in diabetes: lifestyle changes related to obesity, eating behavior, and physical activity. , 2001, Diabetes care.

[76]  G. Eisenbarth,et al.  MICA polymorphism is associated with type 1 diabetes in the Korean population. , 2001, Diabetes care.

[77]  Claude Bouchard,et al.  Handbook of obesity , 1997 .

[78]  D. Nutt,et al.  Does blinding of readers affect the results of meta-analyses? , 1997 .

[79]  R Lo,et al.  The development and evaluation of a computer-aided diabetes education program. , 1996, The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation.

[80]  J. Sallis,et al.  Lifetime history of relapse from exercise. , 1990, Addictive behaviors.

[81]  M. Hynes,et al.  Meta-analysis of the effects of educational and psychosocial interventions on management of diabetes mellitus. , 1988, Journal of clinical epidemiology.

[82]  C. Pratt,et al.  Peer support and nutrition education for older adults with diabetes. , 1987, Journal of nutrition for the elderly.

[83]  S. Colagiuri,et al.  The Diabetes Control and Complications Trial , 1983, Henry Ford Hospital medical journal.

[84]  S. Schultz.  COMPLIANCE WITH THERAPEUTIC REGIMENTS IN PEDIATRICS , 1980 .