Self-management education for adults with type 2 diabetes. A meta-analysis of the effect on glycemic control

Susan L. Norris, Joseph Lau, S. Jay Smith, Christopher H. Schmid, Michael M. Engelgau

Research output: Contribution to journalArticle

1069 Citations (Scopus)

Abstract

OBJECTIVE - To evaluate the efficacy of self-management education on GHb in adults with type 2 diabetes. RESEARCH DESIGN AND METHODS - We searched for English language trials in Medline (1980-1999), Cinahl (1982-1999), and the Educational Resources Information Center database (ERIC) (1980-1999), and we manually searched review articles, journals with highest topic relevance, and reference lists of included articles. Studies were included if they were randomized controlled trials that were published in the English language, tested the effect of self-management education on adults with type 2 diabetes, and reported extractable data on the effect of treatment on GHb. A total of 31 studies of 463 initially identified articles met selection criteria. We computed net change in GHb, stratified by follow-up interval, tested for trial heterogeneity, and calculated pooled effects sizes using random effects models. We examined the effect of baseline GHb, follow-up interval, and intervention characteristics on GHb. RESULTS - On average, the intervention decreased GHb by 0.76% (95% CI 0.34-1.18) more than the control group at immediate follow-up; by 0.26% (0.21% increase-0.73% decrease) at 1-3 months of follow-up; and by 0.26% (0.05-0.48) at ≥4 months of follow-up. GHb decreased more with additional contact time between participant and educator; a decrease of 1% was noted for every additional 23.6 h (13.3-105.4) of contact. CONCLUSIONS - Self-management education improves GHb levels at immediate follow-up, and increased contact time increases the effect. The benefit declines 1-3 months after the intervention ceases, however, suggesting that learned behaviors change over time. Further research is needed to develop interventions effective in maintaining long-term glycemic control.

Original languageEnglish (US)
Pages (from-to)1159-1171
Number of pages13
JournalDiabetes Care
Volume25
Issue number7
DOIs
StatePublished - Jul 2002
Externally publishedYes

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Self Care
Type 2 Diabetes Mellitus
Meta-Analysis
Education
Language
Information Centers
Patient Selection
Research Design
Randomized Controlled Trials
Databases
Control Groups
Research
Therapeutics

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Self-management education for adults with type 2 diabetes. A meta-analysis of the effect on glycemic control. / Norris, Susan L.; Lau, Joseph; Smith, S. Jay; Schmid, Christopher H.; Engelgau, Michael M.

In: Diabetes Care, Vol. 25, No. 7, 07.2002, p. 1159-1171.

Research output: Contribution to journalArticle

Norris, Susan L. ; Lau, Joseph ; Smith, S. Jay ; Schmid, Christopher H. ; Engelgau, Michael M. / Self-management education for adults with type 2 diabetes. A meta-analysis of the effect on glycemic control. In: Diabetes Care. 2002 ; Vol. 25, No. 7. pp. 1159-1171.
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AB - OBJECTIVE - To evaluate the efficacy of self-management education on GHb in adults with type 2 diabetes. RESEARCH DESIGN AND METHODS - We searched for English language trials in Medline (1980-1999), Cinahl (1982-1999), and the Educational Resources Information Center database (ERIC) (1980-1999), and we manually searched review articles, journals with highest topic relevance, and reference lists of included articles. Studies were included if they were randomized controlled trials that were published in the English language, tested the effect of self-management education on adults with type 2 diabetes, and reported extractable data on the effect of treatment on GHb. A total of 31 studies of 463 initially identified articles met selection criteria. We computed net change in GHb, stratified by follow-up interval, tested for trial heterogeneity, and calculated pooled effects sizes using random effects models. We examined the effect of baseline GHb, follow-up interval, and intervention characteristics on GHb. RESULTS - On average, the intervention decreased GHb by 0.76% (95% CI 0.34-1.18) more than the control group at immediate follow-up; by 0.26% (0.21% increase-0.73% decrease) at 1-3 months of follow-up; and by 0.26% (0.05-0.48) at ≥4 months of follow-up. GHb decreased more with additional contact time between participant and educator; a decrease of 1% was noted for every additional 23.6 h (13.3-105.4) of contact. CONCLUSIONS - Self-management education improves GHb levels at immediate follow-up, and increased contact time increases the effect. The benefit declines 1-3 months after the intervention ceases, however, suggesting that learned behaviors change over time. Further research is needed to develop interventions effective in maintaining long-term glycemic control.

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