A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus.

Self-management and psychological interventions for diabetes have become increasingly common and have shown some positive impact on glycemic control. The association of such interventions with psychosocial outcomes is however, less clear. The current review examines the impact of these interventions on psychosocial outcomes including depression, anxiety, adjustment and quality of life. A systematic search of the literature was performed on Medline, Embase and Psychlit. Reference lists were screened for studies that met inclusion/exclusion criteria. Studies were coded on outcomes both over time and relative to control groups. In addition studies were classified as being principally educational, self-management or psychological in type, and the different components in the intervention were determined. Thirty-six studies were identified. Detrimental effects were not generally seen following any type of intervention. Depression seemed to be particularly improved following psychological interventions, whilst quality of life improved more following self-management interventions. A number of methodological issues, such as the specificity of measure used, characteristics of the population and type of intervention were however, influential in the impact of interventions on outcomes. It is recommended that future studies would benefit from being larger with controlled designs, using diabetes specific measures and providing clearer descriptions of intervention components. This will allow greater understanding of what contexts different interventions are most suited to, and which components are key to, improving psychological well-being and quality of life.

[1]  G. Albrektsen,et al.  The effects of participation in a support group on self-assessed quality of life in people with insulin-dependent diabetes mellitus. , 1993, Diabetes research and clinical practice.

[2]  A. Jacobson,et al.  The Evaluation of Two Measures of Quality of Life in Patients With Type I and Type II Diabetes , 1994, Diabetes Care.

[3]  B. McLeod,et al.  Evaluation of a diabetes specialty centre: structure, process and outcome. , 1995, Patient education and counseling.

[4]  D. Chisholm,et al.  Cognitive-behavioural stress management for patients with non-insulin dependent diabetes mellitus , 1997 .

[5]  R. Glasgow,et al.  Brief, Computer-Assisted Diabetes Dietary Self-Management Counseling: Effects on Behavior, Physiologic Outcomes, and Quality of Life , 2000, Medical care.

[6]  B. Naliboff,et al.  Effects of Relaxation Training on Glucose Tolerance and Diabetic Control in Type II Diabetes , 1997, Applied psychophysiology and biofeedback.

[7]  R. Wing,et al.  Lifetime Prevalence of Major Depression and Its Effect on Treatment Outcome in Obese Type II Diabetic Patients , 1992, Diabetes Care.

[8]  D. Muchmore,et al.  Self-monitoring of blood glucose in overweight type 2 diabetic patients , 1994, Acta Diabetologica.

[9]  R. Prager,et al.  A program to reduce onset distress in unselected type I diabetic patients: effects on psychological variables and metabolic control. , 1995, European journal of endocrinology.

[10]  Sharon A. Brown.  Interventions to Promote Diabetes Self-Management: State of the Science , 1999, The Diabetes educator.

[11]  R. Wing,et al.  Comparison of obese NIDDM and nondiabetic women: short- and long-term weight loss. , 1995, Obesity research.

[12]  K. Freedland,et al.  Cognitive Behavior Therapy for Depression in Type 2 Diabetes Mellitus , 1998, Annals of Internal Medicine.

[13]  R. Glasgow.  Outcomes of and for Diabetes Education Research , 1999, The Diabetes educator.

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

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

[16]  T. Skinner,et al.  Effects of educational and psychosocial interventions for adolescents with diabetes mellitus: a systematic review. , 2001, Health technology assessment.

[17]  J. Turtle,et al.  Knowledge and attitude change as predictors of metabolic improvement in diabetes education. , 1990, Social science & medicine.

[18]  Jerome D. Cohen,et al.  A Model Clinical Program for Patients With Diabetes and Vision Impairment , 1989, The Diabetes educator.

[19]  J. Turtle,et al.  Measurement of Emotional Adjustment in Diabetic Patients: Validity and Reliability of ATT39 , 1986, Diabetes Care.

[20]  R. Carney,et al.  Depression and poor glycemic control: a meta-analytic review of the literature. , 2000, Diabetes care.

[21]  Garry Welch,et al.  Assessment of Diabetes-Related Distress , 1995, Diabetes Care.

[22]  R. Glasgow,et al.  Evaluating Diabetes Education: Are we measuring the most important outcomes? , 1992, Diabetes Care.

[23]  Mental Quality of Life , 2001, Social work in health care.

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

[25]  A. Beck,et al.  Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation , 1988 .

[26]  R. Wing,et al.  Effectiveness of a Behavioral Weight Control Program for Blacks and Whites With NIDDM , 1996, Diabetes Care.

[27]  S. Newman,et al.  Psychosocial interventions for caregivers of people with dementia: a systematic review. , 2001, Aging & mental health.

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

[29]  R E Glasgow,et al.  Effects of a Brief Office-Based Intervention to Facilitate Diabetes Dietary Self-Management , 1996, Diabetes Care.

[30]  V. Coates,et al.  Knowledge and diabetes self-management. , 1996, Patient education and counseling.

[31]  W. K. Davis,et al.  A Comparison of Global Versus Disease-Specific Quality-of-Life Measures in Patients With NIDDM , 1997, Diabetes Care.

[32]  R. Rubin,et al.  Quality of life and diabetes , 1999, Diabetes/metabolism research and reviews.

[33]  A. Stewart,et al.  The MOS short-form general health survey. Reliability and validity in a patient population. , 1988, Medical care.

[34]  L. Jaber,et al.  Evaluation of a Pharmaceutical Care Model on Diabetes Management , 1996, The Annals of pharmacotherapy.

[35]  M. Hendryx,et al.  The Effectiveness of Diabetes Education Programs for Older Patients and Their Spouses , 1989, Journal of the American Geriatrics Society.

[36]  R. Heine,et al.  Effects of cognitive behavioural group training (CBGT) in adult patients with poorly controlled insulin-dependent (type 1) diabetes: a pilot study. , 2001, Patient education and counseling.

[37]  A. Maxwell,et al.  Effects of a Social Support Group, as an Adjunct to Diabetes Training, on Metabolic Control and Psychosocial Outcomes , 1992, The Diabetes educator.

[38]  J. Aikens,et al.  Psychological predictors of glycemic change with relaxation training in non-insulin-dependent diabetes mellitus. , 1997, Psychotherapy and psychosomatics.

[39]  A. Belton,et al.  Continuous Monitoring of Health Status Outcomes: Experience With a Diabetes Education Program , 1995, The Diabetes educator.

[40]  F. Strian,et al.  Coping with fear of long-term complications in diabetes mellitus: a model clinical program. , 1995, Psychotherapy and psychosomatics.

[41]  D. Cox,et al.  Blood glucose awareness training (BGAT-2): long-term benefits. , 2001, Diabetes care.

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

[43]  J. Piette,et al.  The effect of automated calls with telephone nurse follow-up on patient-centered outcomes of diabetes care: a randomized, controlled trial. , 2000, Medical care.

[44]  T. Tankova,et al.  Education of diabetic patients--a one year experience. , 2001, Patient education and counseling.

[45]  N. Mutrie,et al.  A randomized, controlled trial to study the effect of exercise consultation on the promotion of physical activity in people with Type 2 diabetes: a pilot study , 2001, Diabetic medicine : a journal of the British Diabetic Association.

[46]  R. Rubin,et al.  The Effect of a Diabetes Education Program Incorporating Coping Skills Training on Emotional Well-Being and Diabetes Self-Efficacy , 1993 .

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

[48]  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.

[49]  R. Rubin,et al.  Levels and Risks of Depression and Anxiety Symptomatology Among Diabetic Adults , 1997, Diabetes Care.

[50]  F. Pomero,et al.  Group visits improve metabolic control in type 2 diabetes: a 2-year follow-up. , 2001, Diabetes care.

[51]  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.