Behavioral Programs for Type 2 Diabetes Mellitus
Open Access
- 1 December 2015
- journal article
- research article
- Published by American College of Physicians in Annals of Internal Medicine
- Vol. 163 (11), 848-860
- https://doi.org/10.7326/m15-1400
Abstract
Background: Behavioral programs may improve outcomes for individuals with type 2 diabetes, but there is a large diversity of behavioral interventions and uncertainty about how to optimize the effectiveness of these programs. Purpose: To identify factors moderating the effectiveness of behavioral programs for adults with type 2 diabetes. Data Sources: 6 databases (1993 to January 2015), conference proceedings (2011–2014), and reference lists. Study Selection: Duplicate screening and selection of 132 randomized, controlled trials evaluating behavioral programs compared with usual care, active controls, or other behavioral programs. Data Extraction: One reviewer extracted and another verified data. Two reviewers independently assessed risk of bias. Data Synthesis: Behavioral programs were grouped on the basis of program content and delivery methods. A Bayesian network meta-analysis showed that most lifestyle and diabetes self-management education and support programs (usually offering ≥11 contact hours) led to clinically important improvements in glycemic control (≥0.4% reduction in hemoglobin [Hb] A1c), whereas most diabetes self-management education programs without added support—especially those offering 10 or fewer contact hours—provided little benefit. Programs with higher effect sizes were more often delivered in person than via technology. Lifestyle programs led to the greatest reductions in body mass index. Reductions in HbA1c seemed to be greater for participants with a baseline HbA1c level of 7.0% or greater, adults younger than 65 years, and minority persons (subgroups with ≥75% nonwhite participants). Limitations: All trials had medium or high risk of bias. Subgroup analyses were indirect, and therefore exploratory. Most outcomes were reported immediately after the interventions. Conclusion: Diabetes self-management education offering 10 or fewer hours of contact with delivery personnel provided little benefit. Behavioral programs seem to benefit persons with suboptimal or poor glycemic control more than those with good control. Primary Funding Source: Agency for Healthcare Research and Quality. (PROSPERO registration number: CRD42014010515)Keywords
This publication has 100 references indexed in Scilit:
- A randomized comparison of a commercially available portion-controlled weight-loss intervention with a diabetes self-management education programNutrition & Diabetes, 2013
- The Effect of a Structured Behavioral Intervention on Poorly Controlled DiabetesJAMA Internal Medicine, 2011
- Twelve-month outcomes of an Internet-based diabetes self-management support programPatient Education and Counseling, 2011
- Effect of Problem-Solving-Based Diabetes Self-Management Training on Diabetes Control in a Low Income Patient SampleJournal of General Internal Medicine, 2011
- Long-term outcomes from a multiple-risk-factor diabetes trial for Latinas: ¡Viva Bien!Translational Behavioral Medicine, 2011
- Managing the Space between Visits: A Randomized Trial of Disease Management for Diabetes in a Community Health CenterJournal of General Internal Medicine, 2010
- Controlled Trial of Nursing Interventions to Improve Health Outcomes of Older African American Women With Type 2 DiabetesNursing Research, 2009
- Evaluating the efficacy of an empowerment-based self-management consultant intervention: results of a two-year randomized controlled trialEducation Thérapeutique du Patient - Therapeutic Patient Education, 2009
- The Effects of a Web-Based Intervention on the Physical Outcomes Associated with Diabetes Among Adults Age 60 and Older: A Randomized TrialDiabetes Technology & Therapeutics, 2007
- Combination of direct and indirect evidence in mixed treatment comparisonsStatistics in Medicine, 2004