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Table 3 —

Effect of self-management training on lifestyle behaviors, psychological outcomes, and quality of life

Referencen, F/U interval, and mean ageInterventionsOutcomesComments
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 
Referencen, F/U interval, and mean ageInterventionsOutcomesComments
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.

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