Towards a better understanding of self-management interventions in type 2 diabetes: A meta-regression analysis

      Highlights

      • Implementation of skills and information related attributes are variable in the existing. DSME programs, because such attributes are not considered a priori.
      • Different attributes contribute to achievement of different levels of outcome in T2D.
      • Skills related attributes significantly improved immediate outcomes like knowledge.
      • Information related attributes improved longer term outcomes like quality of life.
      • Individual attributes may target specific outcomes so generic interventions that do not consider each attribute may not lead to the desired benefit.

      Abstract

      Aims

      Attributes that operationally conceptualize diabetes self-management education (DSME) interventions have never been studied previously to assess their impact on relevant outcomes of interest in people with type 2 diabetes (T2D). The aim of this study was to determine the impact of existing interventions classified by their delivery of skills or information related attributes on immediate (knowledge), intermediate (physical activity), post-intermediate (HbA1c), and long-term (quality of life) outcomes in people with T2D.

      Methods

      PubMed, Embase, PsycINFO, and Cochrane Library/Cochrane CENTRAL as well as the grey literature were searched to identify interventional studies that examined the impact of DSME interventions on the four different outcomes. Eligible studies were selected and appraised independently by two reviewers. A meta-regression analysis was performed to determine the impact of delivery of the skills- and information-related attributes on the chosen outcomes.

      Results

      142 studies (n = 25,511 participants) provided data, of which 39 studies (n = 5278) reported on knowledge, 39 studies (n = 8323) on physical activity, 99 studies (n = 17,178) on HbA1c and 24 studies (n = 5147) on quality of life outcomes. Meta-regression analyses demonstrated that skills-related attributes had an estimated effect suggesting improvement in knowledge (SMD [standardized mean difference] increase of 0.80; P = 0.025) and that information-related attributes had an estimated effect suggesting improvement in quality of life (SMD increase of 0.96; P = 0.405). Skill- and information-related attributes did not have an estimated effect suggesting improvement in physical activity or in HbA1c.

      Conclusions

      The study findings demonstrate that the skills and information related attributes contribute to different outcomes for people with T2D. This study provides, for the first time, preliminary evidence for differential association of the individual DSME attributes with different levels of outcome.

      Abbreviations:

      PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), PROSPERO (a prospective register of systematic reviews), Rayyan (a web and mobile app for systematic reviews)

      Keywords

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