DePue and colleagues conducted a cluster RCT in American Samoa that primarily used home visits and individual rather than group sessions [36]. Focus 3 – Results of the Objective Examinations and Test Results Focus 2 – Your (or patient’s) Lifestyle. RCTs are not the only form of evidence generation in the field of health policy and research [77], and diverse research strategies are needed in conditions like type 2 diabetes that have a strong clinical evidence base yet weak evidence on implementation [3,78]. Epub 2009 Oct 1. 2003). Psychobehavioural model of variables influencing self-management and clinical outcome in diabetes, Figure 2:. Carpenter R(1), DiChiacchio T(2), Barker K(1). Resources, We defined these interventions as diabetes education or support alone. DURATION, INTENSITY AND MODE OF DELIVERY: Intervention durations ranged from 2 days to 1 year, with many falling into the range of 6 to 10 weeks. Writing – review & editing, Affiliation Summary of findings: We did not assess blood pressure outcomes given our primary interest in the evidence of interventions attempting to achieve glycemic control and prior meta-analyses supporting the effectiveness of health system interventions for blood pressure control [74,81]. Medicine-Pediatrics Residency Program, University of Minnesota, Minneapolis, Minnesota, United States of America, Roles Eight trials were classified as clinic-based multicomponent interventions, which we defined as studies involving multiple types of health workers implementing a bundle of quality improvement or health system strengthening interventions [30,31,58–63]. Type 2 diabetes accounts for 90-95% of diabetes and while type 2 diabetes is more prevalent in people aged 40 years and older, prevalence in younger populations is increasing due to a rise in obesity and physical inactivity in children. : 18-05239-EF-1. The proportion of participants from low- and middle-income countries was inferred to be 60% in the study by Reutens and colleagues [66]. Appropriate management of lifestyle can effectively prevent the development of diabetes mellitus. All 3 trials judged as low risk of bias had null results [32,43,46]. For example, in the case of pharmacist task-sharing interventions, 9 of the 14 studies were classified as being at high risk of bias, 5 were at unclear risk of bias, and none were at low risk of bias. Despite physicians' and patients' knowledge of the importance of glycemic control, Canadian data has shown that only 38% of patients with diabetes have HbA1C levels in the optimal range of 7% or less. No, Is the Subject Area "Randomized controlled trials" applicable to this article? Outcomes of mortality, health-related quality of life, and cost-effectiveness were reported in 19, 11, and 5 studies, respectively. Participant numbers in cluster RCTs are adjusted for design effect as described in the Methods. delivery of intervention, length of intervention, mode of instruction, interventionist etc.)? Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan United States of America, Visualization, Included studies reported at least 1 of the following outcomes: glycemic change, mortality, health-related quality of life, or cost-effectiveness. Endocrine Today reports on five interventions that reduced mortality, comorbid illness, symptoms and critical outcomes in adult patients being treated for type 2 diabetes. Despite the homogeneity in the aims of the interventions, there was substantial clinical heterogeneity in other intervention characteristics such as duration, intensity, setting, mode of delivery (group vs. individual), interventionist, and outcomes of interest (discussed below). Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States of America, Roles To our knowledge, no review has systematically assessed evidence from randomized controlled trials (RCTs) or conducted a meta-analysis. Interventions focusing solely on implementing diabetes education or support within the health system also were effective in improving glycemic control, but the certainty of evidence was low. Continuous Subcutaneous Insulin Infusion (CSII) Pumps for Type 1 and Type 2 Adult Diabetic Populations: An Evidence-Based Analysis. Patterns of Glycemic Variability During a Diabetes Self-Management Educational Program. We included 39 trials in the narrative review and 35 trials in the meta-analysis of glycemic change. A dramatic example of this effect was the Happy Life Club trial in China, in which both trial arms experienced 3.7% within-group HbA1c improvement over 18 months [32]. There were 21,080 total participants enrolled across included studies and 10,060 total participants in the meta-analysis of HbA1c when accounting for the design effect of cluster RCTs. INTERVENTION CHARACTERISTICS: All of the interventions examined in the studies were mapped to the 2007 Self-management Mapping Guide. Significant improvements in dietary behavior were reported in four out of the five studies, representing healthier food choices, improvements in eating habits, reductions in carbohydrates, added sugar, sodium, saturated fat and overall fat intake, and/or increases in dietary knowledge. Agency for Healthcare Research and Quality (US). To present the most common quality criteria in health promotion interventions in type 2 diabetes mellitus (T2DM). Importantly, we included diabetes education or support trials that primarily changed the behavior of health workers within the health system, and we excluded lifestyle trials focusing on patient behavior alone without systems-level change. To provide a range of the effects of individual studies, we calculated an overall prediction interval [24]. We extracted study elements including the 4 outcomes, country, setting, duration and follow-up, number of participants enrolled, intervention description, and comparator. | This is not an example of the work produced by our Literature Review Service. This Nursing Care Plan is based on 10 key focus areas when managing type 2 diabetes from home. No study’s primary outcome was mortality. Software, An enormous demand is, therefore, placed on patients to self-manage the physical, emotional and psychological aspects of living with a chronic illness. At the same time, the wide prediction interval overlapping 0 in the meta-analysis of HbA1c showed that there was a wide range of effectiveness across studies, and some health system interventions may not be effective in all settings. 3. Evidence-based treatments for diabetes exist, but health systems in LMICs have difficulty meeting diabetes patients’ needs. Despite differences in individual needs to cope with diabetes, there is general agreement for the necessity of supportive programs for patient self-management. The objective of this report is to determine whether behavioural interventions are effective in improving glycemic control in adults with type 2 diabetes. Interventions for Type 2 Diabetes Literature Review. Diabetes is a serious chronic condition affecting millions of people worldwide and is the sixth leading cause of death in Canada. via advertisements), and two from outpatient diabetes clinics. Home telemonitoring for type 2 diabetes: an evidence-based analysis. Formal analysis, In HICs, components with the largest effect sizes have been team change, patient education or patient self-management, electronic registries, and promotion of patient–provider communication [7]. Evidence-based analyses have been prepared for each of these five areas: insulin pumps, behavioural interventions, bariatric surgery, home telemonitoring, and community based care. This review has notable strengths. In the overall meta-analysis of HbA1c from 35 trials, we found that health system interventions modestly improved glycemic control on average. Background: Type 2 diabetes mellitus has been identified as one of the … This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry's newly released Diabetes Strategy.After an initial review of the strategy and consultation with experts, the secretariat identified five key areas in which evidence was needed. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. Visualization, NCI CPTC Antibody Characterization Program. Health system interventions can help address this gap by improving the delivery of diabetes care within health systems. , the number needed to treat to prevent one case of type 2 diabetes is 6.4 when the duration of intervention ranges from 1.8 to 4.6 years. Databases were chosen to be inclusive of international and interdisciplinary literature. Multiple reports from the same study were identified by reviewing the country setting, intervention details, and authorship list. The quality of the evidence was assessed as being either high, moderate, low, or very low according to the GRADE methodology. Two studies involved nursing case management interventions. We justify our use of the EPOC definition as reasonable given its use in prior Cochrane EPOC reviews on health systems in LMICs. Division of Hospital Medicine, Department of Internal Medicine, National Clinician Scholars Program, University of Michigan, Ann Arbor, Michigan, United States of America, Roles The interviews focused on use of a smartphone and the effects on motivation for health behavior change. Writing – review & editing, Affiliations Using an insulin pump can be a good alternative to injecting with an insulin pen. Reference lists were also checked for relevant studies. School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America, Roles Randomised controlled trials with a pre-test/post-test design that evaluated a diabetes self-management programme compared with no intervention in adults (at least 18 years) with type 2 diabetes were eligible for inclusion. Most studies incorporated primary care doctors in a team-based intervention [30,31,59,60,62,63], and the study by Ali and colleagues incorporated endocrinologists [58]. Formal analysis, (E) Intensity of the interventions varied widely from 6 hours over 2 days, to 52 hours over 1 year; however, the majority consisted of interventions of 6 to 15 hours. Psychological interventions for Type 2 diabetes control: A1c, blood glucose, weight, BMI, & psychological distress. Abstracts were reviewed by a single author and studies meeting the inclusion criteria outlined above were obtained. Studies are listed in the figure by first author [28–36,38–42, 44–55,57–60,62–66]. Our review complements prior meta-analyses of studies primarily from HICs showing the benefit of systems-level quality improvement interventions on surrogate outcomes such as HbA1c, blood pressure, and cholesterol [7–9]. Software, We conducted a meta-analysis for the glycemic outcome of hemoglobin A1c (HbA1c). doi: 10.2196/18922. Further research is needed to assess non-glycemic … https://doi.org/10.1371/journal.pmed.1003434.s001, https://doi.org/10.1371/journal.pmed.1003434.s002, https://doi.org/10.1371/journal.pmed.1003434.s003, https://doi.org/10.1371/journal.pmed.1003434.s004, https://doi.org/10.1371/journal.pmed.1003434.s005, https://doi.org/10.1371/journal.pmed.1003434.s006, https://doi.org/10.1371/journal.pmed.1003434.s007, https://doi.org/10.1371/journal.pmed.1003434.s008, https://doi.org/10.1371/journal.pmed.1003434.s009, https://doi.org/10.1371/journal.pmed.1003434.s010, https://doi.org/10.1371/journal.pmed.1003434.s011, https://doi.org/10.1371/journal.pmed.1003434.s012, https://doi.org/10.1371/journal.pmed.1003434.s013, https://doi.org/10.1371/journal.pmed.1003434.s014, https://doi.org/10.1371/journal.pmed.1003434.s015, https://doi.org/10.1371/journal.pmed.1003434.s016. If outcomes were missing or not reported, we linked the reports together for extraction and.! 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