Effect of self-management training on glycemic control
| 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 sessions as needed C: Started same education 4 weeks later | Decreased HbA1c at 4 weeks I vs. C, P < 0.05 | I more visits than C No BL statistics Attrition 29%, dropouts not equal to completers at BL |
| Low participation rate, but NSD participants and nonparticipants | ||||
| 34 | n = 345; F/U immediate; 58 years | I: Nine multimedia education classes over 1.5 years C: Usual care | NSD HbA1c or FBS | No mention blinding assessor Low participation rate; nonparticipants older, more male |
| 35 | n = 77; F/U 6–18 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 | Decreased FBS for C and I at 1 month, NSD between groups NSD from BL at 6 months | No BL comparison statistics; no attrition information; No blinding for diet history Low recruitment rate and no information on nonparticipants |
| 47 | n = 51; F/U 12 months from BL; 53 years | I: Three weekly didactic, small group sessions q4 months + q2 months visit with doctor | Decreased HbA1c and FBS in I vs. C, P < 0.05 Exact values not given | I more visits than C No information on participation rates |
| C: Visit with doctor q2 months | ||||
| 57 | n = 31; F/U 1 week, HbA1c F/U 2 months; 65 years | I: Four weekly TC after hospital discharge: identify deficits and teach C: No TC or other contact | NSD HbA1c between groups | I more contacts than C Unclear if assessor blinded 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 | Decreased FBS 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 | ||||
| 26 | n = 80; F/U 6 months from BL; 53 years | I: Group sessions: didactic and discussions; no details duration or frequency; F/U q3 months C: Care at general medical clinic q3 months | Decreased FBS in I vs. C at 6 months (9.7 vs. 6.4 mmol/l), P < 0.01 | Attrition 25%, no comparison dropouts to completers |
| 27,28 | n = 532; F/U 12–14 months; 57 years | I: Average 2.4 sessions × 1.5-h over 2 months + home visit, TC F/U, contracting, skill excercises, goal-setting; over 26 months C: Usual care | Decreased HbA1c in I (0.43%), P < 0.05, increased in C (0.35%)Decreased FBS I vs. C, P < 0.05 | I more visits than C Attrition 51%, differences dropouts and completers No blinding assessor Low participation rate |
| 29 | n = 238; F/U 3, 6, 12 months post BL; 56 years | I-1: 13 individual sessions in 12 months I-2: Three-day group interactive course + F/U 3 and 9 months + 2 individual sessions I-3: Six or more individual sessions based on cognitive behavioral theory, TC F/U over 12 months C: 2 × 1-h group education | Decreased HbA1c for all groups at all F/U intervals NSD between groups | BL differences: I-2 better educated; I-1 had longer duration DM I more visits than C Dropouts longer duration DM than completers Unclear if study population represents target population |
| 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 HbA1c at 6 months | More C excluded due to poor control I more visits than C No mention blinding assessor |
| C: One-day didactic teaching | Nonparticipants older and heavier | |||
| 32 | n = 174; F/U 4–6 months; 57 years | I-1: Computer knowledge assessment program (KAP) + interactive computer teaching (60 min)I-2: KAP (20–40 min) + feedback I-3: KAP only C: No intervention | Decreased HbA1c I-2 (−1.3%, P < 0.05) and I-3 (−0.08%, P < 0.05) | Randomization by year and month birth (no details given)I more contact than C NIDDM results reported here (49% of total study population “IDDM”) |
| 40,60 | n = 558; F/U 6 months; 45 years | I-1: Collaborative education by HCW, 3 h/week × 4 weeks I-2: Same education led by fellow patient C: No intervention I based on Fishbein and Ajzen Health Belief Model | NSD HbA1c at 6 months | Hospitals randomized I more visits than C Uncertain blinding assessor |
| 48 | n = 82; F/U 6 months post BL; 56 years | I-1: 11 × 2-h weekly didactic course + 1 individual session I-2: 11-week course + three individual sessions: barriers and support C: Usual care | FBS and HbA1c decreased for I-1 and I-2 at 3 and 6 months, P < 0.05 | No BL statistics comparing groups I more visits than C Attrition 40%, no comparison dropouts to completers Volunteer study population |
| 50 | n = 40; F/U 3 months; 57 years | I: CAI, 4 × 1-h session: didactic, some feedback and testing C: Didactic group teaching; 4 × 3-h | Decreased GHb I (relative change 11%), P < 0.05, increased C (14%), P < 0.05, between group difference, P = 0.001 | No BL group comparison statistics Low participation rate, no information on nonparticipants or dropouts |
| 54 | n = 1.07; F/U 1, 4 months; 60 years | I: 2 × 2-h group didactic + practice + feedback + usual care | NSD BS at 4 months | Randomized by hospital number No blinding assessor |
| C: Usual care: individual education based on perceived patient need Both in IP setting | No information on participation rates | |||
| 55 | n = 41; F/U 2 months; 60 years | I-1: Three-day program + group session with pharmacist | NSD % change in BS between I and C | No BL comparisons I more contact than C |
| I-2: Three-day program + individual session with pharmacist; TC F/U | 23% had unusable data for SMBG | |||
| C: Standard center 3-day education program | ||||
| 59 | n = 60; F/U 3 months from BL; 55 years | I: Three-day group education, with F/U of 4 TC and 1 home visit; reinforce knowledge and skills | NSD HbA1c between groups | I more contact than C Unclear if study population represents target population |
| C: Three-day group education | ||||
| 87 | n = 247; F/U 12 months from BL; 54 years | I: 12 weekly sessions over 3 months; Spanish videos, followed by 14 group support sessions in 9 months, by lay HCW C: Wait listed for the intervention | Decreased GHb 1.7% in I, increased 0.3% in C Decreased FBS 18.9 mg/dl in I, increased 3.9 in C | No BL comparison I more contact than C No information on attrition No mention blinding assessor No statistics |
| 96 | n = 156; F/U ? immediate; 58 years | I-1: Patient selects behavior for improvement I-2: Behavioral strategies to increase compliance I-3: Behavioral strategies + instruction on behavioral analysis C: Routine care with consistent F/U by RN:I-1,2,3 based on social cognitive theory I over 13 months | NSD GHb I and C | No information on attrition Volunteer study population Number of patient contacts unclear F/U interval unclear |
| 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 GHb or BS at 32 weeks | Attrition 24%, no comparison dropouts to completers No mention blinding assessor Unclear if study population represents target population |
| 99 | n = 56; F/U 6 months; 64 years | I: Monthly ×6 group sessions: behavior modification (contracts, feedback), general knowledge C: Usual care | Decreased GHb immediate F/U I and C (P <0.05), NSD between groups; NSD at 6 months Decreased FBS I at immediate F/U, NSD between groups | I more contact than C Attrition 32%, no comparison dropouts to completers Participation rate 37%, no comparison participants to nonparticipants |
| 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 HbA1c I-1 (−2.4%, P < 0.025) and I-2 (−3.3%, P < 0.001)Decreased HbA1c correlated with decreased CHO variation, P < 0.02 | No mention blinding assessor Study population selected by researchers; low participation rate Type of diabetes unclear (“insulin dependent”) |
| 36 | n = 87; F/U 12 months from BL; 56 years | I: Five group sessions over 6 months, focus on weight loss | Decreased HbA1c I at 6 months, P < 0.001; NSD I vs. C at 1 year | |
| C: Individual education on weight loss by dietitian; 3 or more visits in 12 months | ||||
| 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 of teaching | NSD HbA1 or fructosamine at immediate F/U Decreased HbA1 at 18 months (10.8 to 9.6, P < 0.001) | I more contact than C Attrition appears to be 76% at 12 months F/U; no comparison dropouts to completers No mention blinding assessor Crossover design No information on patient recruitment |
| 43 | n = 201; F/U 6 months; 53 years | I: Culturally appropriate flashcards: diet, SMBG; delivered by lay HCW | Decreased HbA1c in I (−0.34%, P > 0.05) | I more contact than C |
| C: Usual care | Intensity of intervention unclear | |||
| 49 | n = 41, F/U 6 months; 61 years | I: Psychologist-led group sessions on PA and diet | Decreased HbA1c for I and C, NSD between groups | Dropouts (22%) had higher mean BS; equal number dropouts I and C |
| C: Didactic lectures on diet and DM Both groups 10 × 1-h sessions over 6 months | Decreased mean BS at 6 months for I, between group difference, P < 0.05 | Low participation rate, no information on nonparticipants | ||
| 66 | n = 148; F/U 6 months from BL; 55 years | I: Advice to decrease fat to <30% total calorie intake C: Advice to decrease CHO to <40% total calorie intake Both I and C received individual counseling by dietitian; three home visits | NSD HbA1c between groups NSD fasting plasma glucose between groups | |
| 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 | NSD HbA1c at 12 months | Unclear if food record reviewers were 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 Both groups 3 visits/3 months basic education before randomization | Decreased FBS for I > C at 15 months, P = 0.02;NSD 27 months NSD HbA1c 15 and 27 months | I more visits than C No mention blinding assessor No information on nonparticipants I more contact than C |
| 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 | NSD GHb | |
| C: Review session × 3 | ||||
| 71 | n = 60; F/U 12 weeks from BL; 55 years | I: Individualized advice on low glycemic index foods | Decreased FBS I and C, significant only for I, P < 0.05 | No mention blinding assessor Unclear how much intervention time |
| C: Standard, individualized diet advice | Decreased fructosamine I vs. C, P < 0.05 | |||
| 72 | n = 78; F/U 2 months; 42–75 years | I-1: 5 × 2-h weekly education: calories, fat, fiber | NSD GHb | No BL information I more visits than C |
| I-2: I-1 + goal setting, problem-solving, feedback | More attrition in C, no comparison dropouts to completers | |||
| C: Wait listed for I | 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 | NSD HbA1 immediate or 6 months | Incomplete BL statistics I more visits than C No mention blinding assessor Volunteer study population Crossover design Type of DM uncertain (“IDDM”) |
| 74 | n = 102; F/U 3, 6 months from BL; 67 years | I: 10 weekly sessions: problem-solving, increased self efficacy, diet and PA focus C: Wait listed for I | Decreased HbA1c in I and C at 3 months (0.5%), NSD between groups, return to BL at 6 months | Randomization blocked by medication I more visits than C Volunteer study population |
| 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 diet and exercise sessions, based on social action theory | Decreased HbA1c at 3 months (−1.5%) and 6 months (−1.1%), P < 0.01 | I more visits than C More C dropouts, no comparison dropouts to completers Volunteer study population |
| C: One didactic class and two mailings | ||||
| 77 | n = 53; F/U 16 weeks, 16 months from BL; 55 years | I-1: 16 weekly sessions: behavioral modification, calorie logs, group PA, monetary incentives | Decreased FBS and HbA1c all groups at 16 weeks, P < 0.01, NSD between groups | I more visits than C Volunteer study population |
| I-2: 16 weekly didactic sessions nutrition and PA | NSD FBS and HbA1c at 16 months | |||
| C: Four monthly didactic sessions | ||||
| 78,97 | n = 79; F/U immediate; 68 years | I-1: 10 × 60-min diet education sessions over 4 months; adapted for elderly | Decreased HbA1c at 8 weeks, for I-2, P < 0.05, not maintained at 16 weeks | Randomized by site No BL comparisons or attrition information |
| I-2: I-1 + peer support: group sessions, modeling, reinforcement C: Usual care | I more visits than C Community recruitment; volunteer study population | |||
| 79,100,101 | n = 76; F/U 3, 6, 18 months from BL; 54 years | I-1: Diet focus; goal-setting, modify environment I-2: PA focus with participation I-3: Diet + PA C: Didactic teaching All groups: 10 × 2-h weekly sessions: I based on behavior and cognitive modification strategies | Decreased BS I-1 vs. C at 6 months, P < 0.037; NSD HbA1cDecreased HbA1c 1–3 vs. C at 18 months (difference 1.8%, P < 0.05) | Randomized by group meeting attended Volunteer study population |
| 80 | n = 40; F/U 2, 5 months from BL; 59 years | I: 3 × 1.5-h individual learning activity packages with diet information, goals, activities C: 3 × 1.5-h didactic lectures | Decreased HbA1c in C (4.5%) at 5 months, P < 0.05; NSD I group | Attrition 23%, no comparison dropouts to completers Volunteer study population from DM education program |
| 81,102 | n = 247; F/U 6 months from BL; 57 years | I: Three or more individual visits with dietitian, over 6 weeks, following practice guidelines C-1: One visit producing nutrition care plan C-2: Nonrandomized comparison group; no intervention | Decreased FBS and HbA1c I at 6 months, P < 0.001; decreased C-1, P < 0.01; NSD between I and C-1 | Nonrandomized C-2 C less time with dietitian Attrition 28% for lab studies, unclear if dropouts equal completers at BL Volunteer study population or physician-referred |
| 83 | n = 596; F/U immediate, 6 months; 51 years | I: More nutrition content, follow food pyramid | Decreased HbA1c in C (0.9%, P = 0.035) | Randomized into choice/no choice of program, then I and C |
| C: Usual education, given meal plan Both I and C: 5 × 2-h weekly group sessions | Patient choice had no effect | Attrition 28%, dropouts younger, more male No mention blinding assessor Physician-referred patients or volunteers | ||
| 84 | n = 163; F/U immediate, 6 months; 64 years | I: Six monthly sessions on diet C: Usual care; wait listed | Decreased postprandial BS at 6 months in I vs. C, P = 0.009 | No BL statistics I more visits than C |
| Attrition 47%, but dropouts equal completers at BL | ||||
| No information on patient recruitment Type of DM unclear | ||||
| 88 | n = 80; F/U 12 months from BL; 56 years | I: Six individual sessions on diet, by nurse | Decreased FBS all groups, P < 0.01, NSD between groups | No BL statistics |
| C: Physician gave handout at initial visit on weight loss Both groups 6 visits/12 months | Decreased HbA1c C females and I males, P < 0.001, NSD between groups | |||
| 90 | n = 50; F/U 1 year from B/L; 54 years | I: Focused on relationship weight loss and BS control; monetary incentives C: Weight loss program | NSD HbA1c at 1 year for I or C | Volunteer study population |
| Both groups: 12 weekly meetings, then monthly ×6, F/U in 3 months; behavioral weight control program | ||||
| 91 | n = 120; F/U 7, 11 months from BL; 54 years | I-1: Six monthly small-group meetings, diet and PA information; audio-visual materials culturally sensitive | NSD HbA1c between or within groups at 7 or 11 months | I more visits than C Attrition 32% at 11 months, NSD dropouts to completers |
| I-2: 1-h didactic + five monthly discussions on BS control | ||||
| C: 1-h didactic only | ||||
| 92 | n = 40; F/U immediate, 6 weeks; 54 years | I: Behavioral group: 6 × 1.5-h weekly meetings; cues for eating, daily record | Decreased BS immediate F/U for I, P < 0.05, NSD 6 weeks NSD between groups for BS | I more visits than C Unclear how patients selected |
| C: Individual diet counseling, total 1.25 h | ||||
| 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 | NSD FBS either group Decreased fructosamine both groups at 1 month, P < 0.0001, return to BL at 6 months | I more contact than C |
| 94 | n = 23; F/U 6 months from BL; 33–70 years | I: Self-management skills (stimulus control, monitoring, reinforcement); 5 diet classes/day for 5 days C: Conventional teaching 1 h/day × 5;Both groups: 5-days IP admission; F/U q2 weeks for 2 months, then 3 and 6 months | FBS decreased both groups, NSD between groups at 6 months | Randomized by week of admission No BL statistics No mention blinding assessor Patients selected by physicians |
| 95 | n = 120; 12 months from BL; 61 years | I: Group education (diet, PA, BS control) q3 months × 4 C: Usual care | NSD HbA1c, FBS | I more contact than C Unclear if study population represents target population |
| 4. Skills teaching interventions | ||||
| 61 | n = 20; F/U 1 year from end 16-week I; 53 years | I: Information on how to use BS measures by adjusting diet and PA C: Self-monitoring of BS; no feedback Both groups: 13 sessions over 16 weeks, then 9 in 6 months; didactic and participatory; focus on weight control | Decreased HbA1c both I and C at immediate F/U, P < 0.0001, NSD between groups, NSD from BL at 1 year | No mention blinding assessor Volunteer study population |
| 63 | n = 50; F/U 6 months; adult | I: Additional participatory teaching on foot care during OP education | Decreased HbA1c I, P = 0.002 and C, P = 0.051 | Randomized by week entering program; no BL comparisons |
| C: Usual education, with routine, didactic foot education | No values or between group statistics | Attrition 35% I, 44% C, no comparison dropouts to completers | ||
| Both groups: 5 days OP DM education | No mention blinding assessor No demographic data; type of DM unclear | |||
| 5. Coping skills interventions | ||||
| 85 | n = 64; F/U 6 weeks; 50 years | I: 6 × 2-h weekly group sessions: patient empowerment, goal-setting, problem-solving, stress management C: Wait listed | Decreased HbA1c I > C P = 0.05, I decreased 0.73% | No BL comparisons; 18 patients not randomly assigned I more contact than C Volunteer study population 64% DM2 HbA1c measured immediately after program for C, 6 weeks after for I |
| 86 | n = 32; F/U 2 years from BL; 68 years | I-1: Six weekly sessions + 18 monthly support group sessions: coping, discussion, education | Decreased HbA1c I-1 and I-2 vs. C at 2 years, P < 0.05; NSD between I-1 and I-2 | 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: Usual care | No information on attrition Unclear if study population represents target population | |||
| Type of DM unclear | ||||
| 105 | n = 55; F/U 3, 6, 12, 18 months from BL; 53 years | I-1: Behavior modification: focus on self-control procedures; records of diet and exercise | NSD HbA1c | |
| I-2: Cognitive modification: focus on cognitions; self-statements; goal-setting | ||||
| I-3: Cognitive-behavior modification: combined I-1 and I-2 | ||||
| C: Relaxation training to cope with stress All groups got nine weekly sessions of 1.5 h |
| 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 sessions as needed C: Started same education 4 weeks later | Decreased HbA1c at 4 weeks I vs. C, P < 0.05 | I more visits than C No BL statistics Attrition 29%, dropouts not equal to completers at BL |
| Low participation rate, but NSD participants and nonparticipants | ||||
| 34 | n = 345; F/U immediate; 58 years | I: Nine multimedia education classes over 1.5 years C: Usual care | NSD HbA1c or FBS | No mention blinding assessor Low participation rate; nonparticipants older, more male |
| 35 | n = 77; F/U 6–18 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 | Decreased FBS for C and I at 1 month, NSD between groups NSD from BL at 6 months | No BL comparison statistics; no attrition information; No blinding for diet history Low recruitment rate and no information on nonparticipants |
| 47 | n = 51; F/U 12 months from BL; 53 years | I: Three weekly didactic, small group sessions q4 months + q2 months visit with doctor | Decreased HbA1c and FBS in I vs. C, P < 0.05 Exact values not given | I more visits than C No information on participation rates |
| C: Visit with doctor q2 months | ||||
| 57 | n = 31; F/U 1 week, HbA1c F/U 2 months; 65 years | I: Four weekly TC after hospital discharge: identify deficits and teach C: No TC or other contact | NSD HbA1c between groups | I more contacts than C Unclear if assessor blinded 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 | Decreased FBS 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 | ||||
| 26 | n = 80; F/U 6 months from BL; 53 years | I: Group sessions: didactic and discussions; no details duration or frequency; F/U q3 months C: Care at general medical clinic q3 months | Decreased FBS in I vs. C at 6 months (9.7 vs. 6.4 mmol/l), P < 0.01 | Attrition 25%, no comparison dropouts to completers |
| 27,28 | n = 532; F/U 12–14 months; 57 years | I: Average 2.4 sessions × 1.5-h over 2 months + home visit, TC F/U, contracting, skill excercises, goal-setting; over 26 months C: Usual care | Decreased HbA1c in I (0.43%), P < 0.05, increased in C (0.35%)Decreased FBS I vs. C, P < 0.05 | I more visits than C Attrition 51%, differences dropouts and completers No blinding assessor Low participation rate |
| 29 | n = 238; F/U 3, 6, 12 months post BL; 56 years | I-1: 13 individual sessions in 12 months I-2: Three-day group interactive course + F/U 3 and 9 months + 2 individual sessions I-3: Six or more individual sessions based on cognitive behavioral theory, TC F/U over 12 months C: 2 × 1-h group education | Decreased HbA1c for all groups at all F/U intervals NSD between groups | BL differences: I-2 better educated; I-1 had longer duration DM I more visits than C Dropouts longer duration DM than completers Unclear if study population represents target population |
| 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 HbA1c at 6 months | More C excluded due to poor control I more visits than C No mention blinding assessor |
| C: One-day didactic teaching | Nonparticipants older and heavier | |||
| 32 | n = 174; F/U 4–6 months; 57 years | I-1: Computer knowledge assessment program (KAP) + interactive computer teaching (60 min)I-2: KAP (20–40 min) + feedback I-3: KAP only C: No intervention | Decreased HbA1c I-2 (−1.3%, P < 0.05) and I-3 (−0.08%, P < 0.05) | Randomization by year and month birth (no details given)I more contact than C NIDDM results reported here (49% of total study population “IDDM”) |
| 40,60 | n = 558; F/U 6 months; 45 years | I-1: Collaborative education by HCW, 3 h/week × 4 weeks I-2: Same education led by fellow patient C: No intervention I based on Fishbein and Ajzen Health Belief Model | NSD HbA1c at 6 months | Hospitals randomized I more visits than C Uncertain blinding assessor |
| 48 | n = 82; F/U 6 months post BL; 56 years | I-1: 11 × 2-h weekly didactic course + 1 individual session I-2: 11-week course + three individual sessions: barriers and support C: Usual care | FBS and HbA1c decreased for I-1 and I-2 at 3 and 6 months, P < 0.05 | No BL statistics comparing groups I more visits than C Attrition 40%, no comparison dropouts to completers Volunteer study population |
| 50 | n = 40; F/U 3 months; 57 years | I: CAI, 4 × 1-h session: didactic, some feedback and testing C: Didactic group teaching; 4 × 3-h | Decreased GHb I (relative change 11%), P < 0.05, increased C (14%), P < 0.05, between group difference, P = 0.001 | No BL group comparison statistics Low participation rate, no information on nonparticipants or dropouts |
| 54 | n = 1.07; F/U 1, 4 months; 60 years | I: 2 × 2-h group didactic + practice + feedback + usual care | NSD BS at 4 months | Randomized by hospital number No blinding assessor |
| C: Usual care: individual education based on perceived patient need Both in IP setting | No information on participation rates | |||
| 55 | n = 41; F/U 2 months; 60 years | I-1: Three-day program + group session with pharmacist | NSD % change in BS between I and C | No BL comparisons I more contact than C |
| I-2: Three-day program + individual session with pharmacist; TC F/U | 23% had unusable data for SMBG | |||
| C: Standard center 3-day education program | ||||
| 59 | n = 60; F/U 3 months from BL; 55 years | I: Three-day group education, with F/U of 4 TC and 1 home visit; reinforce knowledge and skills | NSD HbA1c between groups | I more contact than C Unclear if study population represents target population |
| C: Three-day group education | ||||
| 87 | n = 247; F/U 12 months from BL; 54 years | I: 12 weekly sessions over 3 months; Spanish videos, followed by 14 group support sessions in 9 months, by lay HCW C: Wait listed for the intervention | Decreased GHb 1.7% in I, increased 0.3% in C Decreased FBS 18.9 mg/dl in I, increased 3.9 in C | No BL comparison I more contact than C No information on attrition No mention blinding assessor No statistics |
| 96 | n = 156; F/U ? immediate; 58 years | I-1: Patient selects behavior for improvement I-2: Behavioral strategies to increase compliance I-3: Behavioral strategies + instruction on behavioral analysis C: Routine care with consistent F/U by RN:I-1,2,3 based on social cognitive theory I over 13 months | NSD GHb I and C | No information on attrition Volunteer study population Number of patient contacts unclear F/U interval unclear |
| 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 GHb or BS at 32 weeks | Attrition 24%, no comparison dropouts to completers No mention blinding assessor Unclear if study population represents target population |
| 99 | n = 56; F/U 6 months; 64 years | I: Monthly ×6 group sessions: behavior modification (contracts, feedback), general knowledge C: Usual care | Decreased GHb immediate F/U I and C (P <0.05), NSD between groups; NSD at 6 months Decreased FBS I at immediate F/U, NSD between groups | I more contact than C Attrition 32%, no comparison dropouts to completers Participation rate 37%, no comparison participants to nonparticipants |
| 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 HbA1c I-1 (−2.4%, P < 0.025) and I-2 (−3.3%, P < 0.001)Decreased HbA1c correlated with decreased CHO variation, P < 0.02 | No mention blinding assessor Study population selected by researchers; low participation rate Type of diabetes unclear (“insulin dependent”) |
| 36 | n = 87; F/U 12 months from BL; 56 years | I: Five group sessions over 6 months, focus on weight loss | Decreased HbA1c I at 6 months, P < 0.001; NSD I vs. C at 1 year | |
| C: Individual education on weight loss by dietitian; 3 or more visits in 12 months | ||||
| 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 of teaching | NSD HbA1 or fructosamine at immediate F/U Decreased HbA1 at 18 months (10.8 to 9.6, P < 0.001) | I more contact than C Attrition appears to be 76% at 12 months F/U; no comparison dropouts to completers No mention blinding assessor Crossover design No information on patient recruitment |
| 43 | n = 201; F/U 6 months; 53 years | I: Culturally appropriate flashcards: diet, SMBG; delivered by lay HCW | Decreased HbA1c in I (−0.34%, P > 0.05) | I more contact than C |
| C: Usual care | Intensity of intervention unclear | |||
| 49 | n = 41, F/U 6 months; 61 years | I: Psychologist-led group sessions on PA and diet | Decreased HbA1c for I and C, NSD between groups | Dropouts (22%) had higher mean BS; equal number dropouts I and C |
| C: Didactic lectures on diet and DM Both groups 10 × 1-h sessions over 6 months | Decreased mean BS at 6 months for I, between group difference, P < 0.05 | Low participation rate, no information on nonparticipants | ||
| 66 | n = 148; F/U 6 months from BL; 55 years | I: Advice to decrease fat to <30% total calorie intake C: Advice to decrease CHO to <40% total calorie intake Both I and C received individual counseling by dietitian; three home visits | NSD HbA1c between groups NSD fasting plasma glucose between groups | |
| 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 | NSD HbA1c at 12 months | Unclear if food record reviewers were 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 Both groups 3 visits/3 months basic education before randomization | Decreased FBS for I > C at 15 months, P = 0.02;NSD 27 months NSD HbA1c 15 and 27 months | I more visits than C No mention blinding assessor No information on nonparticipants I more contact than C |
| 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 | NSD GHb | |
| C: Review session × 3 | ||||
| 71 | n = 60; F/U 12 weeks from BL; 55 years | I: Individualized advice on low glycemic index foods | Decreased FBS I and C, significant only for I, P < 0.05 | No mention blinding assessor Unclear how much intervention time |
| C: Standard, individualized diet advice | Decreased fructosamine I vs. C, P < 0.05 | |||
| 72 | n = 78; F/U 2 months; 42–75 years | I-1: 5 × 2-h weekly education: calories, fat, fiber | NSD GHb | No BL information I more visits than C |
| I-2: I-1 + goal setting, problem-solving, feedback | More attrition in C, no comparison dropouts to completers | |||
| C: Wait listed for I | 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 | NSD HbA1 immediate or 6 months | Incomplete BL statistics I more visits than C No mention blinding assessor Volunteer study population Crossover design Type of DM uncertain (“IDDM”) |
| 74 | n = 102; F/U 3, 6 months from BL; 67 years | I: 10 weekly sessions: problem-solving, increased self efficacy, diet and PA focus C: Wait listed for I | Decreased HbA1c in I and C at 3 months (0.5%), NSD between groups, return to BL at 6 months | Randomization blocked by medication I more visits than C Volunteer study population |
| 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 diet and exercise sessions, based on social action theory | Decreased HbA1c at 3 months (−1.5%) and 6 months (−1.1%), P < 0.01 | I more visits than C More C dropouts, no comparison dropouts to completers Volunteer study population |
| C: One didactic class and two mailings | ||||
| 77 | n = 53; F/U 16 weeks, 16 months from BL; 55 years | I-1: 16 weekly sessions: behavioral modification, calorie logs, group PA, monetary incentives | Decreased FBS and HbA1c all groups at 16 weeks, P < 0.01, NSD between groups | I more visits than C Volunteer study population |
| I-2: 16 weekly didactic sessions nutrition and PA | NSD FBS and HbA1c at 16 months | |||
| C: Four monthly didactic sessions | ||||
| 78,97 | n = 79; F/U immediate; 68 years | I-1: 10 × 60-min diet education sessions over 4 months; adapted for elderly | Decreased HbA1c at 8 weeks, for I-2, P < 0.05, not maintained at 16 weeks | Randomized by site No BL comparisons or attrition information |
| I-2: I-1 + peer support: group sessions, modeling, reinforcement C: Usual care | I more visits than C Community recruitment; volunteer study population | |||
| 79,100,101 | n = 76; F/U 3, 6, 18 months from BL; 54 years | I-1: Diet focus; goal-setting, modify environment I-2: PA focus with participation I-3: Diet + PA C: Didactic teaching All groups: 10 × 2-h weekly sessions: I based on behavior and cognitive modification strategies | Decreased BS I-1 vs. C at 6 months, P < 0.037; NSD HbA1cDecreased HbA1c 1–3 vs. C at 18 months (difference 1.8%, P < 0.05) | Randomized by group meeting attended Volunteer study population |
| 80 | n = 40; F/U 2, 5 months from BL; 59 years | I: 3 × 1.5-h individual learning activity packages with diet information, goals, activities C: 3 × 1.5-h didactic lectures | Decreased HbA1c in C (4.5%) at 5 months, P < 0.05; NSD I group | Attrition 23%, no comparison dropouts to completers Volunteer study population from DM education program |
| 81,102 | n = 247; F/U 6 months from BL; 57 years | I: Three or more individual visits with dietitian, over 6 weeks, following practice guidelines C-1: One visit producing nutrition care plan C-2: Nonrandomized comparison group; no intervention | Decreased FBS and HbA1c I at 6 months, P < 0.001; decreased C-1, P < 0.01; NSD between I and C-1 | Nonrandomized C-2 C less time with dietitian Attrition 28% for lab studies, unclear if dropouts equal completers at BL Volunteer study population or physician-referred |
| 83 | n = 596; F/U immediate, 6 months; 51 years | I: More nutrition content, follow food pyramid | Decreased HbA1c in C (0.9%, P = 0.035) | Randomized into choice/no choice of program, then I and C |
| C: Usual education, given meal plan Both I and C: 5 × 2-h weekly group sessions | Patient choice had no effect | Attrition 28%, dropouts younger, more male No mention blinding assessor Physician-referred patients or volunteers | ||
| 84 | n = 163; F/U immediate, 6 months; 64 years | I: Six monthly sessions on diet C: Usual care; wait listed | Decreased postprandial BS at 6 months in I vs. C, P = 0.009 | No BL statistics I more visits than C |
| Attrition 47%, but dropouts equal completers at BL | ||||
| No information on patient recruitment Type of DM unclear | ||||
| 88 | n = 80; F/U 12 months from BL; 56 years | I: Six individual sessions on diet, by nurse | Decreased FBS all groups, P < 0.01, NSD between groups | No BL statistics |
| C: Physician gave handout at initial visit on weight loss Both groups 6 visits/12 months | Decreased HbA1c C females and I males, P < 0.001, NSD between groups | |||
| 90 | n = 50; F/U 1 year from B/L; 54 years | I: Focused on relationship weight loss and BS control; monetary incentives C: Weight loss program | NSD HbA1c at 1 year for I or C | Volunteer study population |
| Both groups: 12 weekly meetings, then monthly ×6, F/U in 3 months; behavioral weight control program | ||||
| 91 | n = 120; F/U 7, 11 months from BL; 54 years | I-1: Six monthly small-group meetings, diet and PA information; audio-visual materials culturally sensitive | NSD HbA1c between or within groups at 7 or 11 months | I more visits than C Attrition 32% at 11 months, NSD dropouts to completers |
| I-2: 1-h didactic + five monthly discussions on BS control | ||||
| C: 1-h didactic only | ||||
| 92 | n = 40; F/U immediate, 6 weeks; 54 years | I: Behavioral group: 6 × 1.5-h weekly meetings; cues for eating, daily record | Decreased BS immediate F/U for I, P < 0.05, NSD 6 weeks NSD between groups for BS | I more visits than C Unclear how patients selected |
| C: Individual diet counseling, total 1.25 h | ||||
| 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 | NSD FBS either group Decreased fructosamine both groups at 1 month, P < 0.0001, return to BL at 6 months | I more contact than C |
| 94 | n = 23; F/U 6 months from BL; 33–70 years | I: Self-management skills (stimulus control, monitoring, reinforcement); 5 diet classes/day for 5 days C: Conventional teaching 1 h/day × 5;Both groups: 5-days IP admission; F/U q2 weeks for 2 months, then 3 and 6 months | FBS decreased both groups, NSD between groups at 6 months | Randomized by week of admission No BL statistics No mention blinding assessor Patients selected by physicians |
| 95 | n = 120; 12 months from BL; 61 years | I: Group education (diet, PA, BS control) q3 months × 4 C: Usual care | NSD HbA1c, FBS | I more contact than C Unclear if study population represents target population |
| 4. Skills teaching interventions | ||||
| 61 | n = 20; F/U 1 year from end 16-week I; 53 years | I: Information on how to use BS measures by adjusting diet and PA C: Self-monitoring of BS; no feedback Both groups: 13 sessions over 16 weeks, then 9 in 6 months; didactic and participatory; focus on weight control | Decreased HbA1c both I and C at immediate F/U, P < 0.0001, NSD between groups, NSD from BL at 1 year | No mention blinding assessor Volunteer study population |
| 63 | n = 50; F/U 6 months; adult | I: Additional participatory teaching on foot care during OP education | Decreased HbA1c I, P = 0.002 and C, P = 0.051 | Randomized by week entering program; no BL comparisons |
| C: Usual education, with routine, didactic foot education | No values or between group statistics | Attrition 35% I, 44% C, no comparison dropouts to completers | ||
| Both groups: 5 days OP DM education | No mention blinding assessor No demographic data; type of DM unclear | |||
| 5. Coping skills interventions | ||||
| 85 | n = 64; F/U 6 weeks; 50 years | I: 6 × 2-h weekly group sessions: patient empowerment, goal-setting, problem-solving, stress management C: Wait listed | Decreased HbA1c I > C P = 0.05, I decreased 0.73% | No BL comparisons; 18 patients not randomly assigned I more contact than C Volunteer study population 64% DM2 HbA1c measured immediately after program for C, 6 weeks after for I |
| 86 | n = 32; F/U 2 years from BL; 68 years | I-1: Six weekly sessions + 18 monthly support group sessions: coping, discussion, education | Decreased HbA1c I-1 and I-2 vs. C at 2 years, P < 0.05; NSD between I-1 and I-2 | 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: Usual care | No information on attrition Unclear if study population represents target population | |||
| Type of DM unclear | ||||
| 105 | n = 55; F/U 3, 6, 12, 18 months from BL; 53 years | I-1: Behavior modification: focus on self-control procedures; records of diet and exercise | NSD HbA1c | |
| I-2: Cognitive modification: focus on cognitions; self-statements; goal-setting | ||||
| I-3: Cognitive-behavior modification: combined I-1 and I-2 | ||||
| C: Relaxation training to cope with stress All groups got nine weekly sessions of 1.5 h |
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; DM, 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.