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Effectiveness of Interactive Self‐Management Interventions in Individuals With Poorly Controlled Type 2 Diabetes: A Meta‐Analysis of Randomized Controlled Trials
Author(s) -
Cheng Li,
Sit Janet W. H.,
Choi Kaichow,
Chair Sekying,
Li Xiaomei,
He Xiaole
Publication year - 2017
Publication title -
worldviews on evidence‐based nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.052
H-Index - 49
eISSN - 1741-6787
pISSN - 1545-102X
DOI - 10.1111/wvn.12191
Subject(s) - glycemic , meta analysis , medicine , randomized controlled trial , psychological intervention , glycated hemoglobin , diabetes management , type 2 diabetes , self management , medline , cochrane library , strictly standardized mean difference , diabetes mellitus , physical therapy , psychiatry , endocrinology , machine learning , computer science , political science , law
Aims To identify, assess, and summarize available scientific evidence on the effectiveness of interactive self‐management interventions on glycemic control and patient‐centered outcomes in individuals with poorly controlled type 2 diabetes. Methods Major English and Chinese electronic databases including Medline, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and WanFang Data were searched to identify randomized controlled trials that reported the effectiveness of interactive self‐management interventions in individuals with poorly controlled type 2 diabetes (glycated hemoglobin [HbA1c] ≥ 7.5% or 58 mmol/mol), from inception to June 2015. Data extraction and risk‐of‐bias assessment were performed by two reviewers independently. Meta‐analysis was performed using Review Manager 5.3. Results A total of 16 trials with 3,545 participants were included in the meta‐analysis. Interactive self‐management interventions could have a beneficial effect in individuals with poorly controlled type 2 diabetes in reducing HbA1c (mean difference: −0.43%, 95% CI: −0.67% to −0.18%), improving diabetes knowledge (standardized mean difference [SMD]: 0.30, 95% CI: 0.03 to 0.58), enhancing self‐efficacy (SMD: 0.29, 95% CI: 0.14 to 0.44), and reducing diabetes‐related distress (SMD: −0.21, 95% CI: −0.39 to −0.04). Self‐management interventions supported with theory and structured curriculum showed desirable results in glycemic control. The behavioral change techniques, including providing feedback on performance, problem‐solving, and action planning, were associated with a significant reduction in HbA1c. Linking Evidence to Action Individuals with poorly controlled type 2 diabetes could benefit from interactive self‐management interventions. Interventions targeting patients with poorly controlled diabetes, those who are at the greatest risk of developing complications, should be prioritized. Our findings indicate that providing feedback on performance, problem‐solving, and action planning are promising behavioral change techniques specifically for individuals with poor glycemic control.