Effect of self-management training on lifestyle behaviors, psychological outcomes, and quality of life
| Reference . | n, F/U interval, and mean age . | Interventions . | Outcomes . | Comments . |
|---|---|---|---|---|
| 1. Didactic, knowledge, and information interventions | ||||
| 33 | n = 60; F/U immediate, 4 weeks; ?age | I: Four weekly group sessions: individual as needed C: Started same education 4 weeks later | Decreased anxiety at 4 weeks I vs. C, P < 0.05 NSD depression score | No BL statistics I more visits than C Attrition 29%, dropouts not equal completers at BL |
| Low participation rate, but NSD participants and nonparticipants | ||||
| 35 | n = 77; F/U 6 to 18 months from BL; 33 years | I: Five days IP teaching: didactic, individual F/U q3 months, phone access; instruction in self-adjustment insulin C: Five days IP “traditional” education + written information; 3 × 1.5-h sessions; q3 months F/U | NSD diet adherence at 18 months | No BL comparison statistics No attrition information No blinding for diet history Low recruitment rate and no information on nonparticipants |
| 65,109 | n = 1,139; F/U 5 years; 46 years | I-1: Didactic individual and group sessions q3 months: focus on diet, PA, smoking, BP, and BS control I-2: I-1 + clofibric acid C: Usual care at DM clinics; q3–4 months | Increased polyunsaturated fats in I vs. C, P < 0.01 Increased PA in I vs. C, P < 0.01 | No mention blinding assessor Low participation rate, no information on nonparticipants Clofibric acid arm double-blinded |
| 2. Collaborative, knowledge, and information interventions | ||||
| 30 | n = 46; F/U immediate, 6 months; 66 years | I: 8 × 2-h small group sessions over 3 months; problem- and participant-focused | NSD exercise | I more visits than C More C excluded due to poor control No mention blinding assessor |
| C: One day didactic teaching | Nonparticipants older and heavier | |||
| 40,60 | n = 558; F/U 6 months; 45 years | I-1: Collaborative education by HCW, 3 h/week × 4 weeks | NSD hypoglycemic reactions, anxiety, PA | Hospitals randomized I more visits than C |
| I-2: Same education, led by fellow patient | Uncertain blinding assessor | |||
| C: No intervention I based on Fishbein and Ajzen Health Belief Model | ||||
| 54 | n = 107; F/U 1, 4 months; 60 years | 1: 2 × 2-h group didactic + practice + feedback + usual care | Increased exercise I vs. C at 1 and 4 months, P = 0.05 | Randomized by hospital number No binding assessor |
| C: Usual care: individual education based on perceived patient need Both in IP setting | No information on participation rates | |||
| 98 | n = 22; F/U 32 weeks from baseline; 61 years | I: Weekly to biweekly home visits: nutrition, exercise, foot care, SMBG; by nursing students C: Usual care | NSD food assessment, 3-day dietary recall, functional health status between groups | Attrition 24%, no comparison dropouts to completers No mention blinding assessor Unclear if study population represents target population |
| 3. Lifestyle interventions | ||||
| 31 | n = 40; F/U 6 months from BL; 35 years | I-1: Lunch demonstrations I-2: Videotape education C: Dietitian instruction and written information Three visits total for all groups over 6 months | Decreased CHO variation in I-1 and I-2, P < 0.01 | No mention blinding assessor Study population selected by researchers; low participation rate Type of diabetes unclear (“insulin dependent”) |
| 38 | n = 32; F/U immediate; 53 years | I: Two sessions: dietitian and CAI C: 2 × 30-min sessions: only dietitian Teaching for both over approximately 1 month | Decreased % fat intake I, P < 0.005; NSD C | No BL statistics Unclear if blinding assessor Type of DM unclear |
| 39 | n = 105; F/U immediate, 12 months; 45 years | I: Interactive computer program on diet; 90 min/month over 6 months C: Wait listed for I Both groups received 5 days teaching | Decreased caloric and fat intake for those in I with initial high intake, P < 0.05 | I more contact than C Attrition appears to be 76% at 12 months F/U, no comparison dropouts to completers |
| No mention blinding assessor No information on patient recruitment Crossover design | ||||
| 66 | n = 148; F/U 6 months from BL; 55 years | I: Advice to decrease fat to <30% total calorie intake C: Advice to decreased CHO to <40% total calorie intake Both individual counseling by dietitian, three home visits | Decreased fat and cholesterol intake, increased CHO for I, between group difference, P < 0.001 | |
| 67,68,104 | n = 206; F/U 12 months from BL; 62 years | I: Single visit: focus on diet; goal-setting, interactive video on barriers; F/U q3 months C: Usual care q3 months | Improvement in I vs. C at 12 months for food habits, 4-day food record, kcal/day, % calories from fat, P < 0.05 | Unclear if food record reviewers blinded Low participation rate; participants differ from nonparticipants |
| 69,82,89,103 | n = 86; F/U 15, 27 months from BL; 53 years | I: Six individual visits at 2-month intervals: intensive therapy for weight, BS control, diet, PA; then q3 months visits C: Usual care q2–3 months | Fat intake <30% of total energy, I > C at 15 months, P < 0.05 NSD energy intake NSD physical activity, Vo2max at 15 months | I more visits than C No mention blinding assessor No information on nonparticipants |
| Both groups got 3 visits/3 months basic education before randomization | ||||
| 70 | n = 75; F/U 12 months from BL; 61 years | I: Educational videos, personal and family support q2 weeks for 6 months + 3 h counseling by dietitian C: Review session × 3 | Decreased self-reported fat intake, P = 0.0002 NSD self-reported total food or fiber intake | I more contact than C |
| 71 | n = 60; F/U 12 weeks from BL; 55 years | I: Individualized advice on low glycemic index foods C: Standard, individualized diet advice | Consumption of lower glycemic index foods I > C, P < 0.01 | No mention blinding assessor Unclear how much intervention time |
| 72 | n = 78; F/U 2 months; 42–75 years | I-1: 5 × 2-h weekly education: calories, fat, fiber I-2: I-1 + goal setting, problem-solving, feedback C: Wait listed for I | Decreased calories and % fat F/U for I-2 at immediate and 2 months, P < 0.01 Decreased calories for I-1 at 2 months, P < 0.05 | No BL information I more visits than C More attrition in C, no comparison dropouts to completers Unclear if assessor blinded Unclear how study population recruited |
| 73 | n = 70 F/U immediate 6 months; 42 years | I: Monthly (or more) meetings: diet and PA prescription, feedback, behavior modification C: Usual care, wait listed for I | Decreased total fat intake at immediate F/U, I vs. C, P = 0.047 Deterioration of diet improvements at 6 months | Incomplete BL statistics I more visits than C No mention blinding assessor Volunteer study population; cross-over design Type of DM uncertain (“IDDM”) |
| 74 | n = 102; F/U 3, 6 months from BL; 67 years | I: Ten weekly sessions: problem-solving, increased self-efficacy; diet and PA focus C: Wait listed for I | Increased problem-solving for I at 3 and 6 months; between group, P < 0.05 | Randomization blocked by medication I more visits than C Volunteer study population |
| 75 | n = 66; F/U 4 months; 30–86 years | I: Five × 90-min weekly sessions by nurse: diet and PA, barriers, social and group support | Improved health practices (diet, PA) I vs. C, P = 0.015 | No BL statistics Volunteer study population Number of visits uncertain |
| C: No information on care received | ||||
| 76 | n = 64; F/U 3, 6 months from BL; 62 years | I: 12 × 1.5-h weekly (didactic) sessions, then 6 × 1.5-h biweekly participatory sessions; based on social action theory | Increased PA 3 months; NSD 6 months | I more visits than C More C dropouts, no comparison dropouts to completers |
| C: One didactic class and two mailings | Volunteer study population | |||
| 77 | n = 53; F/U 16 months from BL; 55 years | I-1: 16 weekly sessions of behavioral modification: calorie logs, group PA, monetary incentives I-2: 16 weekly didactic sessions: nutrition and PA C: Four monthly didactic sessions | Improved eating and PA all groups at 4 months, NSD between groups;regression toward BL at 16 m but remained significant | I more visits than C Volunteer study population |
| 78,97 | n = 79; F/U immediate; 68 years | I-1: 10 × 60-min diet education sessions over 4 months; adapted for elderly I-2: I-1 + peer support: group sessions; modeling, reinforcement C: Usual care | Peer support levels correlated with weight loss, glycemic control, P < 0.05 | Randomized by site No BL comparisons or attrition information I more visits than C Community recruitment; volunteer study population |
| 83 | n = 596; F/U immediate, 6 months; 51 years | I: More nutrition content, follow food pyramid C: Usual education, given meal plan Both I and C: 5 × 2-h weekly group sessions | NSD physical function between choice/no choice groups or between I and C | Randomized into choice/no choice of program, then I and C Attrition 28%, dropouts younger, more male No mention blinding assessor Physician-referred patients or volunteers |
| 93 | n = 70; F/U 6 months from BL; 58 years | I: 22 h over 11 weeks, interactive teaching based on cognitive motivational theory C: Didactic teaching, 14 h over 3 days Focus for both I and C: diet and foot care | Increased dietary CHO but NSD between groups Decreased % fat for both groups at 1 month, I > C, P = 0.004 | I more contact than C |
| 95 | n = 20; 12 months from BL; 61 years | I: Group education (diet, PA, BS control) q3 months × 4 C: Usual care | NSD quality of life | I more contact than C Unclear if study population represents target population |
| 106 | n = 53; F/U 16 weeks from BL; 55 years | I-1: Nutrition education: 16 weekly sessions; exchange system diet, goal-setting I-2: Nutrition education: four monthly sessions; exchange system diet, goal-setting C: Behavior modification: 16 weekly visits; calorie-counting diet, goal-setting | Decreased caloric intake and % calories from fat in I and C, P < 0.001; NSD between groups | I-2 more visits than C Volunteer study population I-1 and I-2 combined in analysis, as NSD between groups |
| 107 | n = 152; F/U 10, 14 weeks from BL; >50 years | I: 10 × 2-h sessions over 14 weeks, culturally sensitive video; nutrition focus C: No intervention | Decreased intake kcal/d C males, P = 0.04 Decreased cholesterol intake C females, P = 0.013 | No BL comparisons I more visits than C Attrition 30.2%No information on dropouts No information on blinding assessor Volunteer study population |
| 4. Skills teaching interventions | ||||
| 90 | n = 50; F/U 1 year from BL; 54 years | I: Focused on relationship weight loss and BS control; monetary incentives | Reduction in medications both groups, NSD between groups | Volunteer study population |
| C: Weight loss program Both groups: 12 weekly meetings, then monthly × 6, F/U in 3 months; behavioral weight control program | Decreased caloric intake C, P < 0.004 Decreased depression both groups, NSD between groups | |||
| 5. Coping skills interventions | ||||
| 86 | n = 32; F/U 2 years; 68 years | I-1: Six weekly sessions + 18 monthly support group sessions: coping, discussion, education | Increased quality of life Decreased stress I-1 vs. C at 6 months P < 0.05 | C is nonrandomized comparison group More visits for I-1 > I-2 > C |
| I-2: Six weekly sessions only; wait list for support group C: Visual care | No information on attrition Unclear if study population represents target population | |||
| Type of DM unclear |
| Reference . | n, F/U interval, and mean age . | Interventions . | Outcomes . | Comments . |
|---|---|---|---|---|
| 1. Didactic, knowledge, and information interventions | ||||
| 33 | n = 60; F/U immediate, 4 weeks; ?age | I: Four weekly group sessions: individual as needed C: Started same education 4 weeks later | Decreased anxiety at 4 weeks I vs. C, P < 0.05 NSD depression score | No BL statistics I more visits than C Attrition 29%, dropouts not equal completers at BL |
| Low participation rate, but NSD participants and nonparticipants | ||||
| 35 | n = 77; F/U 6 to 18 months from BL; 33 years | I: Five days IP teaching: didactic, individual F/U q3 months, phone access; instruction in self-adjustment insulin C: Five days IP “traditional” education + written information; 3 × 1.5-h sessions; q3 months F/U | NSD diet adherence at 18 months | No BL comparison statistics No attrition information No blinding for diet history Low recruitment rate and no information on nonparticipants |
| 65,109 | n = 1,139; F/U 5 years; 46 years | I-1: Didactic individual and group sessions q3 months: focus on diet, PA, smoking, BP, and BS control I-2: I-1 + clofibric acid C: Usual care at DM clinics; q3–4 months | Increased polyunsaturated fats in I vs. C, P < 0.01 Increased PA in I vs. C, P < 0.01 | No mention blinding assessor Low participation rate, no information on nonparticipants Clofibric acid arm double-blinded |
| 2. Collaborative, knowledge, and information interventions | ||||
| 30 | n = 46; F/U immediate, 6 months; 66 years | I: 8 × 2-h small group sessions over 3 months; problem- and participant-focused | NSD exercise | I more visits than C More C excluded due to poor control No mention blinding assessor |
| C: One day didactic teaching | Nonparticipants older and heavier | |||
| 40,60 | n = 558; F/U 6 months; 45 years | I-1: Collaborative education by HCW, 3 h/week × 4 weeks | NSD hypoglycemic reactions, anxiety, PA | Hospitals randomized I more visits than C |
| I-2: Same education, led by fellow patient | Uncertain blinding assessor | |||
| C: No intervention I based on Fishbein and Ajzen Health Belief Model | ||||
| 54 | n = 107; F/U 1, 4 months; 60 years | 1: 2 × 2-h group didactic + practice + feedback + usual care | Increased exercise I vs. C at 1 and 4 months, P = 0.05 | Randomized by hospital number No binding assessor |
| C: Usual care: individual education based on perceived patient need Both in IP setting | No information on participation rates | |||
| 98 | n = 22; F/U 32 weeks from baseline; 61 years | I: Weekly to biweekly home visits: nutrition, exercise, foot care, SMBG; by nursing students C: Usual care | NSD food assessment, 3-day dietary recall, functional health status between groups | Attrition 24%, no comparison dropouts to completers No mention blinding assessor Unclear if study population represents target population |
| 3. Lifestyle interventions | ||||
| 31 | n = 40; F/U 6 months from BL; 35 years | I-1: Lunch demonstrations I-2: Videotape education C: Dietitian instruction and written information Three visits total for all groups over 6 months | Decreased CHO variation in I-1 and I-2, P < 0.01 | No mention blinding assessor Study population selected by researchers; low participation rate Type of diabetes unclear (“insulin dependent”) |
| 38 | n = 32; F/U immediate; 53 years | I: Two sessions: dietitian and CAI C: 2 × 30-min sessions: only dietitian Teaching for both over approximately 1 month | Decreased % fat intake I, P < 0.005; NSD C | No BL statistics Unclear if blinding assessor Type of DM unclear |
| 39 | n = 105; F/U immediate, 12 months; 45 years | I: Interactive computer program on diet; 90 min/month over 6 months C: Wait listed for I Both groups received 5 days teaching | Decreased caloric and fat intake for those in I with initial high intake, P < 0.05 | I more contact than C Attrition appears to be 76% at 12 months F/U, no comparison dropouts to completers |
| No mention blinding assessor No information on patient recruitment Crossover design | ||||
| 66 | n = 148; F/U 6 months from BL; 55 years | I: Advice to decrease fat to <30% total calorie intake C: Advice to decreased CHO to <40% total calorie intake Both individual counseling by dietitian, three home visits | Decreased fat and cholesterol intake, increased CHO for I, between group difference, P < 0.001 | |
| 67,68,104 | n = 206; F/U 12 months from BL; 62 years | I: Single visit: focus on diet; goal-setting, interactive video on barriers; F/U q3 months C: Usual care q3 months | Improvement in I vs. C at 12 months for food habits, 4-day food record, kcal/day, % calories from fat, P < 0.05 | Unclear if food record reviewers blinded Low participation rate; participants differ from nonparticipants |
| 69,82,89,103 | n = 86; F/U 15, 27 months from BL; 53 years | I: Six individual visits at 2-month intervals: intensive therapy for weight, BS control, diet, PA; then q3 months visits C: Usual care q2–3 months | Fat intake <30% of total energy, I > C at 15 months, P < 0.05 NSD energy intake NSD physical activity, Vo2max at 15 months | I more visits than C No mention blinding assessor No information on nonparticipants |
| Both groups got 3 visits/3 months basic education before randomization | ||||
| 70 | n = 75; F/U 12 months from BL; 61 years | I: Educational videos, personal and family support q2 weeks for 6 months + 3 h counseling by dietitian C: Review session × 3 | Decreased self-reported fat intake, P = 0.0002 NSD self-reported total food or fiber intake | I more contact than C |
| 71 | n = 60; F/U 12 weeks from BL; 55 years | I: Individualized advice on low glycemic index foods C: Standard, individualized diet advice | Consumption of lower glycemic index foods I > C, P < 0.01 | No mention blinding assessor Unclear how much intervention time |
| 72 | n = 78; F/U 2 months; 42–75 years | I-1: 5 × 2-h weekly education: calories, fat, fiber I-2: I-1 + goal setting, problem-solving, feedback C: Wait listed for I | Decreased calories and % fat F/U for I-2 at immediate and 2 months, P < 0.01 Decreased calories for I-1 at 2 months, P < 0.05 | No BL information I more visits than C More attrition in C, no comparison dropouts to completers Unclear if assessor blinded Unclear how study population recruited |
| 73 | n = 70 F/U immediate 6 months; 42 years | I: Monthly (or more) meetings: diet and PA prescription, feedback, behavior modification C: Usual care, wait listed for I | Decreased total fat intake at immediate F/U, I vs. C, P = 0.047 Deterioration of diet improvements at 6 months | Incomplete BL statistics I more visits than C No mention blinding assessor Volunteer study population; cross-over design Type of DM uncertain (“IDDM”) |
| 74 | n = 102; F/U 3, 6 months from BL; 67 years | I: Ten weekly sessions: problem-solving, increased self-efficacy; diet and PA focus C: Wait listed for I | Increased problem-solving for I at 3 and 6 months; between group, P < 0.05 | Randomization blocked by medication I more visits than C Volunteer study population |
| 75 | n = 66; F/U 4 months; 30–86 years | I: Five × 90-min weekly sessions by nurse: diet and PA, barriers, social and group support | Improved health practices (diet, PA) I vs. C, P = 0.015 | No BL statistics Volunteer study population Number of visits uncertain |
| C: No information on care received | ||||
| 76 | n = 64; F/U 3, 6 months from BL; 62 years | I: 12 × 1.5-h weekly (didactic) sessions, then 6 × 1.5-h biweekly participatory sessions; based on social action theory | Increased PA 3 months; NSD 6 months | I more visits than C More C dropouts, no comparison dropouts to completers |
| C: One didactic class and two mailings | Volunteer study population | |||
| 77 | n = 53; F/U 16 months from BL; 55 years | I-1: 16 weekly sessions of behavioral modification: calorie logs, group PA, monetary incentives I-2: 16 weekly didactic sessions: nutrition and PA C: Four monthly didactic sessions | Improved eating and PA all groups at 4 months, NSD between groups;regression toward BL at 16 m but remained significant | I more visits than C Volunteer study population |
| 78,97 | n = 79; F/U immediate; 68 years | I-1: 10 × 60-min diet education sessions over 4 months; adapted for elderly I-2: I-1 + peer support: group sessions; modeling, reinforcement C: Usual care | Peer support levels correlated with weight loss, glycemic control, P < 0.05 | Randomized by site No BL comparisons or attrition information I more visits than C Community recruitment; volunteer study population |
| 83 | n = 596; F/U immediate, 6 months; 51 years | I: More nutrition content, follow food pyramid C: Usual education, given meal plan Both I and C: 5 × 2-h weekly group sessions | NSD physical function between choice/no choice groups or between I and C | Randomized into choice/no choice of program, then I and C Attrition 28%, dropouts younger, more male No mention blinding assessor Physician-referred patients or volunteers |
| 93 | n = 70; F/U 6 months from BL; 58 years | I: 22 h over 11 weeks, interactive teaching based on cognitive motivational theory C: Didactic teaching, 14 h over 3 days Focus for both I and C: diet and foot care | Increased dietary CHO but NSD between groups Decreased % fat for both groups at 1 month, I > C, P = 0.004 | I more contact than C |
| 95 | n = 20; 12 months from BL; 61 years | I: Group education (diet, PA, BS control) q3 months × 4 C: Usual care | NSD quality of life | I more contact than C Unclear if study population represents target population |
| 106 | n = 53; F/U 16 weeks from BL; 55 years | I-1: Nutrition education: 16 weekly sessions; exchange system diet, goal-setting I-2: Nutrition education: four monthly sessions; exchange system diet, goal-setting C: Behavior modification: 16 weekly visits; calorie-counting diet, goal-setting | Decreased caloric intake and % calories from fat in I and C, P < 0.001; NSD between groups | I-2 more visits than C Volunteer study population I-1 and I-2 combined in analysis, as NSD between groups |
| 107 | n = 152; F/U 10, 14 weeks from BL; >50 years | I: 10 × 2-h sessions over 14 weeks, culturally sensitive video; nutrition focus C: No intervention | Decreased intake kcal/d C males, P = 0.04 Decreased cholesterol intake C females, P = 0.013 | No BL comparisons I more visits than C Attrition 30.2%No information on dropouts No information on blinding assessor Volunteer study population |
| 4. Skills teaching interventions | ||||
| 90 | n = 50; F/U 1 year from BL; 54 years | I: Focused on relationship weight loss and BS control; monetary incentives | Reduction in medications both groups, NSD between groups | Volunteer study population |
| C: Weight loss program Both groups: 12 weekly meetings, then monthly × 6, F/U in 3 months; behavioral weight control program | Decreased caloric intake C, P < 0.004 Decreased depression both groups, NSD between groups | |||
| 5. Coping skills interventions | ||||
| 86 | n = 32; F/U 2 years; 68 years | I-1: Six weekly sessions + 18 monthly support group sessions: coping, discussion, education | Increased quality of life Decreased stress I-1 vs. C at 6 months P < 0.05 | C is nonrandomized comparison group More visits for I-1 > I-2 > C |
| I-2: Six weekly sessions only; wait list for support group C: Visual care | No information on attrition Unclear if study population represents target population | |||
| Type of DM unclear |
BL, baseline; BS, blood sugar; BP, blood pressure; C, C-1, C-2, control groups; CAI, computer-assisted instruction; CHO, carbohydrate; D/SBP, diastolic/systolic blood pressure; diabetes mellitus; DM2, type 2 diabetes; FBS, fasting blood sugar; F/U, follow-up; HCW, health-care worker; I, I-1, I-2, I-3, intervention groups; IP, inpatient; NSD, no significant difference; OP, outpatient; PA, physical activity; q, every; RN, registered nurse; SD, significant difference; TC, telephone call.