Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis

Aslak Steinsbekk, Lisbeth Ø Rygg, Monde Lisulo, Marit B Rise, Atle Fretheim, Aslak Steinsbekk, Lisbeth Ø Rygg, Monde Lisulo, Marit B Rise, Atle Fretheim

Abstract

Background: Diabetes self-management education (DSME) can be delivered in many forms. Group based DSME is widespread due to being a cheaper method and the added advantages of having patient meet and discuss with each other. assess effects of group-based DSME compared to routine treatment on clinical, lifestyle and psychosocial outcomes in type-2 diabetes patients.

Methods: A systematic review with meta-analysis. Computerised bibliographic database were searched up to January 2008 for randomised controlled trials evaluating group-based DSME for adult type-2 diabetics versus routine treatment where the intervention had at least one session and =/>6 months follow-up. At least two reviewers independently extracted data and assessed study quality.

Results: In total 21 studies (26 publications, 2833 participants) were included. Of all the participants 4 out of 10 were male, baseline age was 60 years, BMI 31.6, HbA1c 8.23%, diabetes duration 8 years and 82% used medication. For the main clinical outcomes, HbA1c was significantly reduced at 6 months (0.44% points; P=0.0006, 13 studies, 1883 participants), 12 months (0.46% points; P=0.001, 11 studies, 1503 participants) and 2 years (0.87% points; P<0.00001, 3 studies, 397 participants) and fasting blood glucose levels were also significantly reduced at 12 months (1.26 mmol/l; P<0.00001, 5 studies, 690 participants) but not at 6 months. For the main lifestyle outcomes, diabetes knowledge was improved significantly at 6 months (SMD 0.83; P=0.00001, 6 studies, 768 participants), 12 months (SMD 0.85; P<0.00001, 5 studies, 955 participants) and 2 years (SMD 1.59; P=0.03, 2 studies, 355 participants) and self-management skills also improved significantly at 6 months (SMD 0.55; P=0.01, 4 studies, 534 participants). For the main psychosocial outcomes, there were significant improvement for empowerment/self-efficacy (SMD 0.28, P=0.01, 2 studies, 326 participants) after 6 months. For quality of life no conclusion could be drawn due to high heterogeneity. For the secondary outcomes there were significant improvements in patient satisfaction and body weight at 12 months for the intervention group. There were no differences between the groups in mortality rate, body mass index, blood pressure and lipid profile.

Conclusions: Group-based DSME in people with type 2 diabetes results in improvements in clinical, lifestyle and psychosocial outcomes.

Figures

Figure 1
Figure 1
Stages of study identification

References

    1. International Diabetes Federation. Diabetes Atlas. Third Edition. International Diabetes Federation, Brussels; 2006.
    1. World Health Organisation. Therapeutic Patient Education: Continuing Education Programmes for Healthcare Providers in the Field of Prevention of Chronic Diseases. Report of a WHO Working Group. 1998.
    1. International Diabetes Federation. International Curriculum for Diabetes Health Professional Education. International Diabetes Federation, Brussels; 2008.
    1. International Diabetes Federation. International Standards for Diabetes Education. International Diabetes Federation, Brussels; 2009.
    1. Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B. National standards for diabetes self-management education. Diabetes Care. 2010;33:S89–S96. doi: 10.2337/dc10-S089.
    1. Department of Health, Diabetes UK. Structured Patient Education in Diabetes. Department of Health, London; 2005.
    1. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655. doi: 10.1136/bmj.a1655.
    1. Griffin SJ, Kinmonth AL, Skinner C, Kelly J. Educational and psychosocial interventions for adults with diabetes: report to the British Diabetic Association. British Diabetic Association, London; 1998.
    1. Brown SA. Effects of educational interventions in diabetes care: a meta-analysis of findings. Nurs Res. 1988;37:223–230.
    1. Brown SA. Studies of educational interventions and outcomes in diabetic adults: a meta-analysis revistited. Patient Educ Couns. 1990;16:189–215. doi: 10.1016/0738-3991(90)90070-2.
    1. Brown SA. Meta-analysis of diabetes patient education research: variations in intervention effects across studies. Res Nurs Health. 1992;15:409–419. doi: 10.1002/nur.4770150603.
    1. Mazzuca SA. Does patient education in chronic disease have any therapeutic value? J Chronic Dis. 1982;35:521–529. doi: 10.1016/0021-9681(82)90071-6.
    1. Mullen PD, Green LW, Persinger MS. Clinical trials of patient education for chronic conditions: a comparative meta-analysis of intervention types. Preventative Med. 1985;14:753–781. doi: 10.1016/0091-7435(85)90070-2.
    1. Padgett D, Mumford E, Hynes M, Carter R. Meta-analysis of the effects of educational and psychosocial interventions on management of diabetes mellitus. J Clin Epidemiol. 1988;41:1007–1030. doi: 10.1016/0895-4356(88)90040-6.
    1. Wing RR. Behavioral treatment of obesity. Its application to type II diabetes. Diabetes Care. 1993;16:193–199. doi: 10.2337/diacare.16.1.193.
    1. NHS Centre for Reviews and. Complications of diabetes: renal disease and promotion of self-management. Eff Health Care. 2000;6:1–12.
    1. Minet L, Moller S, Vach W, Wagner L, Henriksen JE. Mediating the effect of self-care management intervention in type 2 diabetes: a meta-analysis of 47 randomised controlled trials. Patient Educ couns. 2010;80:29–41. doi: 10.1016/j.pec.2009.09.033.
    1. Alam R, Sturt J, Lall R, Winkley K. An updated meta-analysis to assess the effectiveness of psychological interventions delivered by psychological specialists and generalist clinicians on glycaemic control and on psychological status. Patient Educ Couns. 2009;75:25–36. doi: 10.1016/j.pec.2008.08.026.
    1. Albano MG, Crozet C, d’Ivernois JF. Analysis of the 2004-2007 literature on therapeutic patient education in diabetes: results and trends. Acta Diabetol. 2008;45:211–219. doi: 10.1007/s00592-008-0044-9.
    1. Boren SA, Fitzner KA, Panhalkar PS, Specker JE. Costs and benefits associated with diabetes education: a review of the literature. Diabetes Educ. 2009;35:72–96. doi: 10.1177/0145721708326774.
    1. Duke SA, Colagiuri S, Colagiuri R. Individual patient education for people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2009;CD005268:1.
    1. Loveman E, Frampton GK, Clegg AJ. The clinical effectiveness of diabetes education models for type 2 diabetes: a systematic review. Health Technol Assess. 2008;12:1–116.
    1. Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 2001;24:561–587. doi: 10.2337/diacare.24.3.561.
    1. Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002;25:1159–1171. doi: 10.2337/diacare.25.7.1159.
    1. Steed L, Cooke D, Newman S. A systematic review of psychosocial outcomes following education, self-managment and psychological interventions in diabetes mellitus. Patient Educ Couns. 2003;51:5–15. doi: 10.1016/S0738-3991(02)00213-6.
    1. Van Dam HA, Van der Horst F, Van den Borne B, Ryckman R, Crebolder H. Provider-patient interaction in diabetes care: effects on patient self-care and outcomes. A systematic review. Patient Educ Couns. 2003;51:17–28. doi: 10.1016/S0738-3991(02)00122-2.
    1. Zabaleta AM, Forbes A. Structured group-based education for type 2 diabetes in primary care. Br J Community Nurs. 2007;12:158–162.
    1. Deakin T, Mcshane C, Cade J, Williams R. Group based training for self management startegies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005;Issue 2:1.
    1. Green S, Higgins JPT. Cochrane Handbook for Systematic Reviews of Interventions. Wiley-Blackwell, Chichester; 2008.
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DGH. In: Cochrane Handbook for Systematic Reviews of Interventions. Green S, Higgins JPT, editor. Wiley-Blackwell, Chichester; 2008. Assessing risk of bias in included studies; pp. 187–242.
    1. Deeks JJ, Higgins JPT, Altman DG. In: Cochrane Handbook for Systematic Reviews of Interventions. 9. Green S, Higgins JPT, editor. Wiley-Blackwell, Chichester; 2008. Analysing data and undertaking meta-analyses; pp. 243–296.
    1. Adolfsson ET, Walker-Engstrøm ML, Smide B, Wikblad K. Patient education in type 2 diabetes: a randomized controlled 1-year follow up study. Diabetes Res Clin Pract. 2006;76:341–350.
    1. Baradaran HR, Knill-Jones RP, Wallia S, Rodgers A. A controlled trial of the effectiveness of a diabetes education programme in a multi-ethnic community in Glasgow [ISRCTN28317455] BMC Publ Health. 2006;29:134.
    1. Brown SA, Garcia AA, Kouzekanani K, Hanis CL. Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Diabetes Care. 2002;25:259–268. doi: 10.2337/diacare.25.2.259.
    1. Cabrera-Pivaral CE, Gonzalez-Perez G, Vega-Lopez MG, Rias-Merino ED. Impact of participatory education on body mass index and blood glucose in obese type-2 diabetics. Cadernos de Saude Publica. 2004;8:275–281.
    1. Clancy DE, Huang P, Okonofua E, Yeager D, Magruder KM. Group visits: promoting adherence to diabetes guidelines. Soc Gen Intern Med. 2007;16:620–624.
    1. Cooper HC, Booth K, Gill G. Patients' perspectives on diabetes health care education. Theory Pract. 2003;18:191–206.
    1. Deakin TA, Cade JE, Williams R, Greenwood DC. Structured patient education: the diabetes X-PERT Programme makes a difference. Diabet Med. 2006;8:944–954.
    1. Heller SR, Clarke P, Daly H, Davis I, McCulloch DK, Allison SP. et al.Group education for obese patients with type 2 diabetes: greater success at less cost. Diabet Med. 1988;5:552–556. doi: 10.1111/j.1464-5491.1988.tb01050.x.
    1. Holtrop JS, Hickner J, Dosh S, Noel M, Ettenhofer TL. "Sticking to it – diabetes mellitus": a pilot study of an innovative behavior change program for women with type 2 diabetes. Am J Heal Educ. 2002;33:161–166.
    1. Hornsten A, Lundman B, Stenlund H, Sandstrom H. Metabolic improvement after intervention focusing on personal understanding in type 2 diabetes. Diabetes Res Clin Pract. 2004;68:65–74.
    1. Lozano ML, Armale MJ, Tena DI, Sanchez NC. The education of type-2 diabetics: why not in groups? Aten Primaria. 1999;23:485–492.
    1. Lujan J, Ostwald SK, Ortiz M. Promotora diabetes intervention for Mexican Americans. Diabetes Educ. 2007;19:660–670.
    1. Mayer-Davis EJ, D'Antonio AM, Smith SM, Kirkner G, Levin MS, Parra-Medina D. et al.Pounds off with empowerment (POWER): a clinical trial of weight management strategies for black and white adults with diabetes who live in medically underserved rural communities. Am J Public Health. 2004;1:1736–1742.
    1. McKibbin CL, Patterson TL, Norman G, Patrick K, Jin H, Roesch S. et al.A lifestyle intervention for older schizophrenia patients with diabetes mellitus: a randomized controlled trial. Schizophr Res. 2006;8:36–44.
    1. Pennings-van der Eerden LM, Ripken T, van Heijst MP, Schrijvers AP. Evaluation of the impact of a patient education programme for NIDDM patients on knowledge, self-care behaviour, metabolic control and lipid profiles. Gedran en gezondheid. 1991;19:246–260.
    1. Rosal MC, Olendzki B, Reed GW, Gumieniak O, Scavron J, Ockene I. Diabetes self-management among low-income Spanish-speaking patients: a pilot study. Ann Behav Med. 2005;26:225–235.
    1. Sarkadi A, Osenqvist U. Experience-based group education in Type 2 diabetes: a randomised controlled trial. Patient Educ Couns. 2004;2:291–298.
    1. Toobert DJ, Glasgow RE, Strycker LA, Barrera M, Radcliffe JL, Wander RC. et al.Biologic and quality-of-life outcomes from the Mediterranean Lifestyle Program: a randomized clinical trial. Diabetes Care. 2003;15:2288–2293.
    1. Toobert DJ, Glasgow RE, Strycker LA, Barrera M, Ritzwoller DP, Weidner G. Long-term effects of the Mediterranean lifestyle program: a randomized clinical trial for postmenopausal women with type 2 diabetes. Int J Behav Nutr Phys Act. 2007;82:1.
    1. Trento M, Passera P, Tomalino M, Pagnozzi F, Pomero F, Vaccari P. et al.Therapeutic group education in the follow-up of patients with non-insulin treated, non-insulin dependent diabetes mellitus. Diabetes Nutr Metab Clin Exp. 1998;11:212–216.
    1. Trento M, Passera P, Tomalino M, Bajardi M, Pomero F, Allione A. et al.Group visits improve metabolic control in type 2 diabetes: a 2-year follow-up. Diabetes Care. 2001;24:995–1000. doi: 10.2337/diacare.24.6.995.
    1. Trento M, Passera P, Bajardi M, Tomalino M, Grassi G, Borgo E. et al.Lifestyle intervention by group care prevents deterioration of Type II diabetes: a 4-year randomized controlled clinical trial. Diabetologia. 2002;45:1231–1239. doi: 10.1007/s00125-002-0904-8.
    1. Trento M, Passera P, Borgo E, Tomalino M, Bajardi M, Cavallo F. et al.A 5-year randomized controlled study of learning, problem solving ability, and quality of life modifications in people with type 2 diabetes managed by group care. Diabetes Care. 2004;112:670–675.
    1. Wattana C, Srisuphan W, Pothiban L, Upchurch SL. Effects of a diabetes self-management program on glycemic control, coronary heart disease risk, and quality of life among Thai patients with type 2 diabetes. Nurs Heal Sci. 2007;9:135–141. doi: 10.1111/j.1442-2018.2007.00315.x.
    1. Zapotoczky H, Semlitsch B, Herzog G, Bahadori B, Siebenhofer A, Pieber TR. et al.A controlled study of weight reduction in type 2 diabetics treated by two reinforcers. Int J Behav Med. 2001;8:42–49. doi: 10.1207/S15327558IJBM0801_03.
    1. Deakin TA, Cade JE, Williams DDR, Greenwood DC. Empowered patients:better diabetes control, greater freedom to eat, no weight gain! Diabetologia. 2003;46(suppl 2):A90.
    1. Fitzgerald J, Anderson R, Funnell M, Hiss R, Hess G, Davis W. et al.The reliability and validity of a brief diabetes knowledge test. Diabetes Care. 1998;21:706–710. doi: 10.2337/diacare.21.5.706.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere