Effectiveness of lay-led, group-based self-management interventions to improve glycated hemoglobin (HbA1c), self-efficacy, and emergency visit rates among adults with type 2 diabetes: A systematic review and meta-analysis

BACKGROUND Type 2 Diabetes Mellitus (T2DM) is a major health problem worldwide. Proper self-management can improve health outcomes and reduces risk of diabetic complications. Recently, smartphone-based technology has been used for self-management programs but their effectiveness in improving self-efficacy, self-care activities, health-related quality of life (HRQoL) and clinical outcomes for patients with T2DM is not well understood. OBJECTIVE To review the evidence and determine the effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, HRQoL, glycated haemoglobin (HbA1c), body mass index (BMI), blood pressure (BP) levels of adults with T2DM. METHODS A systematic search of five databases (PubMed, Embase, Cochrane, CINAHL and Scopus) was conducted. Study published in English, from January 2007 to January 2018, were considered. Only randomised controlled trials (RCTs) of smartphone-based self-management interventions for patients with T2DM that reported any of the study outcomes were included. Two reviewers independently screened the studies, extracted data and assessed the quality of the studies. Meta-analyses were conducted for the different study outcomes. RESULTS A total of 26 articles, consisting of 22 studies with 2645 participants were included in the review. A meta-analysis conducted on self-efficacy revealed a large improvement of 0.98 (95% confidence interval [CI] 0.42 to 1.55; P < 0.001) with smartphone-based self-management interventions. The effect size on self-care activities was also large (d = 0.90; 95% CI 0.24 to 1.57; P < 0.001). Significant heterogeneity was present among studies pooled for both outcomes and subgroup analyses were conducted for self-efficacy. Smartphone-based self-management interventions also gave a small improvement on HRQoL (d = 0.26; 95% CI 0.06 to 0.47; P = .01) and a significant reduction in HbA1c (pooled MD = -0.55; 95% CI -0.60 to -0.40; P < 0.001). The effects on BMI and BP were not statistically significant. CONCLUSIONS Smartphone-based self-management interventions appear to have beneficial effects on self-efficacy, self-care activities and health-relevant outcomes for patients with T2DM. However, more research with good study designs is needed to evaluate the effectiveness of smartphone-based self-care interventions for T2DM. CLINICALTRIAL NA

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The effectiveness of self‐management programmes for people with type 2 diabetes receiving insulin injection: A systematic review and meta‐analysis

International Journal of Clinical Practice ◽

10.1111/ijcp.14636 ◽

2021 ◽

Author(s):

Wei Liang ◽

Suzanne Hoi Shan Lo ◽

Yetunde Oluwafunmilayo Tola ◽

Ka Ming Chow

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Meta Analysis ◽

Insulin Injection ◽

Self Management

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Tailored mobile text messaging interventions targeting type 2 diabetes self-management: A systematic review and a meta-analysis

Digital Health ◽

10.1177/2055207619845279 ◽

2019 ◽

Vol 5 ◽

pp. 205520761984527 ◽

Cited By ~ 16

Author(s):

Cigdem Sahin ◽

Karen L Courtney ◽

PJ Naylor ◽

Ryan E Rhodes

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Text Messaging ◽

Meta Analysis ◽

Scientific Evidence ◽

Self Management ◽

Reference List ◽

Pool Data ◽

Message Delivery

Objectives This study aimed to identify, assess and summarize available scientiﬁc evidence on tailored text messaging interventions focused on type 2 diabetes self-management. The systematic review concentrated on message design and delivery features, and tailoring strategies. The meta-analysis assessed the moderators of the effectiveness of tailored text messaging interventions. Methods A comprehensive search strategy included major electronic databases, key journal searches and reference list searching for related studies. PRISMA and Cochrane Collaboration's guidelines and recommended tools for data extraction, quality appraisal and data analysis were followed. Data were extracted on participant characteristics (age, gender, ethnicity), and interventional and methodological characteristics (study design, study setting, study length, choice of modality, comparison group, message type, format, content, use of interactivity, message frequency, message timing, message delivery, tailoring strategies and theory use). Outcome measures included diet, physical activity, medication adherence and glycated hemoglobin data (HbA1C). Where possible, a random effects meta-analysis was performed to pool data on the effectiveness of the tailored text messaging interventions and moderator variables. Results The search returned 13 eligible trials for the systematic review and 11 eligible trials for the meta-analysis. The majority of the studies were randomized controlled trials, conducted in high-income settings, used multi-modalities, and mostly delivered informative, educational messages through an automated message delivery system. Tailored text messaging interventions produced a substantial effect ( g = 0.54, 95% CI = 0.08–0.99, p < 0.001) on HbA1C values for a total of 949 patients. Subgroup analyses revealed the importance of some moderators such as message delivery ( QB = 18.72, df = 1, p = 0.001), message direction ( QB = 5.26, df = 1, p = 0.022), message frequency ( QB = 18.72, df = 1, p = 0.000) and using multi-modalities ( QB = 6.18, df = 1, p = 0.013). Conclusions Tailored mobile text messaging interventions can improve glycemic control in type 2 diabetes patients. However, more rigorous interventions with larger samples and longer follow-ups are required to confirm these findings and explore the effects of tailored text messaging on other self-management outcomes.

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Self-management interventions for Type 2 Diabetes: systematic review protocol focusing on patient workload and capacity support

Wellcome Open Research ◽

10.12688/wellcomeopenres.17238.1 ◽

2021 ◽

Vol 6 ◽

pp. 257

Author(s):

Peter Hanlon ◽

Iona Bryson ◽

Holly Morrison ◽

Qasim Rafiq ◽

Kasey Boehmer ◽

...

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Hospital Admissions ◽

Macrovascular Disease ◽

Self Management ◽

Management Support ◽

Patient Capacity ◽

Management Interventions ◽

The Impact

Introduction: People living with type 2 diabetes undertake a range of tasks to manage their condition, collectively referred to as self-management. Interventions designed to support self-management vary in their content, and efficacy. This systematic review will analyse self-management interventions for type 2 diabetes drawing on theoretical models of patient workload and capacity. Methods and analysis: Five electronic databases (Medline, Embase, CENTRAL, CINAHL and PsycINFO) will be searched from inception to 27th April 2021, supplemented by citation searching and hand-searching of reference lists. Two reviewers will independently review titles, abstracts and full texts. Inclusion criteria include Population: Adults with type 2 diabetes mellitus; Intervention: Randomised controlled trials of self-management support interventions; Comparison: Usual care; Outcomes: HbA1c (primary outcome) health-related quality of life (QOL), medication adherence, self-efficacy, treatment burden, healthcare utilization (e.g. number of appointment, hospital admissions), complications of type 2 diabetes (e.g. nephropathy, retinopathy, neuropathy, macrovascular disease) and mortality; Setting: Community. Study quality will be assessed using the Effective Practice and Organisation of Care (EPOC) risk of bias tool. Interventions will be classified according to the EPOC taxonomy and the PRISMS self-management taxonomy and grouped into similar interventions for analysis. Clinical and methodological heterogeneity will be assessed within subgroups, and random effects meta-analyses performed if appropriate. Otherwise, a narrative synthesis will be performed. Interventions will be graded on their likely impact on patient workload and support for patient capacity. The impact of these theoretical constructs on study outcomes will be explored using meta-regression. Conclusion This review will provide a broad overview of self-management interventions, analysed within the cumulative complexity model theoretical framework. Analyses will explore how the workload associated with self-management, and support for patient capacity, impact on outcomes of self-management interventions. Registration number: PROSPERO CRD42021236980.

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Pathways Linking Health Literacy to Self-Management in People with Type 2 Diabetes

Healthcare ◽

10.3390/healthcare9121734 ◽

2021 ◽

Vol 9 (12) ◽

pp. 1734

Author(s):

Eun-Hyun Lee ◽

Young Whee Lee ◽

Duckhee Chae ◽

Kwan-Woo Lee ◽

Seongbin Hong ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Literacy ◽

Social Isolation ◽

Indirect Effect ◽

Self Efficacy ◽

Self Management ◽

Mediation Model ◽

Cross Sectional ◽

Management Interventions

Health literacy is considered to be an emerging determinant of health behaviors and outcomes. The underlying mechanisms linking health literacy to diabetes self-management are currently unclear. This study assessed a mediation model consisting of a direct pathway between health literacy and self-management, and indirect pathways via social isolation only, self-efficacy only, and social isolation and self-efficacy serially in people with type 2 diabetes. A cross-sectional design was employed, and a total of 524 participants were recruited from outpatient clinics of multi-institutions from June 2020 to February 2021. The mediation model was analyzed using the PROCESS macro on SPSS with bootstrap bias-corrected 95% confidence intervals (CIs) with 10,000 bootstrapping iterations. Health literacy positively affected self-management. The estimated indirect effect of health literacy on self-management via social isolation was significant, at 0.018 (95% CI = 0.004–0.036). The indirect effect via self-efficacy was estimated at 0.214 (95% CI = 0.165–0.266). The indirect effect via social isolation and self-efficacy serially was 0.013 (95% CI = 0.006–0.023). The findings of this study suggest that clinical practice can be improved through more comprehensive diabetes self-management interventions that promote all of the components of health literacy, social contacts/networks, and self-efficacy in particular.

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Patient activation and Type 2 diabetes mellitus self-management: a systematic review and meta-analysis

Australian Journal of Primary Health ◽

10.1071/py19204 ◽

2020 ◽

Vol 26 (6) ◽

pp. 431

Author(s):

Hassan Hosseinzadeh ◽

Iksheta Verma ◽

Vinod Gopaldasani

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Clinical Outcomes ◽

Meta Analysis ◽

Patient Activation ◽

Self Management ◽

Haemoglobin A1c

Patient activation has been recognised as a reliable driver of self-management decision-making. This systematic review and meta-analysis examines existing evidence on whether embedding patient activation within Type 2 diabetes mellitus (T2DM) self-management programs can improve patient outcomes. This review has included 10 randomised controlled trials (RCTs) conducted between 2004 and 2019 retrieved from well-known databases such as MEDLINE, PubMed, CINAHL Plus, Scopus, ProQuest and ScienceDirect. The eligible RCTs were excluded if they scored low according to Cochrane Collaboration’s ‘risk of bias’ criteria. Random-effects meta-analyses showed that there were no significance changes in haemoglobin A1C (HbA1c), body mass index (BMI) and patient activation measure (PAM) between intervention and control groups after the intervention; however, the systematic review findings indicated that an improved patient activation level led to significant improvements in T2DM self-management and clinical outcomes including HbA1c level. Studies with a longer follow-up period conducted in community settings and delivered by peer coaches were more likely to lead to significant improvement in both patient activation levels and T2DM self-management and clinical outcomes. This review concludes that patient activation can be used as a reliable tool for improving T2DM self-management and clinical outcomes.

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