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Table 5 —

Effect of self-management training on cardiovascular disease risk factors and cardiovascular disease

Referencen, F/U interval, and mean ageInterventionsOutcomesComments
1. Didactic, knowledge, and information interventions 
34  n = 345; F/U immediate; 58 years I: Nine multimedia education classes over 1.5 years C: Usual care NSD BP, weight, lipids No mention blinding assessor Low participation rate; nonparticipants older, more male 
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 C: Visit with doctor q2 months Decreased weight 2 kg in I vs. C, P < 0.05 NSD cholesterol, triglycerides between groups I more visits than C No information on participation rates 
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 NSD myocardial infarctions, ischemic heart disease, mortality; NSD BMI Increased cholesterol in all groups, NSD between groups No mention blinding assessor Low participation rate, no information on nonparticipants Clofibric acid arm double-blinded 
2. Collaborative, knowledge, and information interventions 
27,28  n = 532; F/U 12–14; 57 years I: Average 2.4 sessions × 1.5 h over 2 months + home visit, TC F/U, contracting, skill exercises, goal-setting; over 26 months C: Usual care Decreased SBP, DBP, between group difference, P < 0.05 Decreased weight I, between group difference 2.8 lb, P < 0.05 I more contact than C Attrition 51%, differences dropouts  and completers No blinding assessor Low participation rate 
29  n = 238; F/U 3, 6, 12 months from BL; 56 years I-1: 13 individual sessions in 12 months I-2: Three-day group interactive course + F/U 3 and 9 months + two individual sessions I-3: Six or more individual sessions based on cognitive behavior theory, TC F/U over 12 months C: 2 × 1-h group education NSD SBP, total cholesterol and BMI Decreased DBP I-3 vs. C at 12  months, P < 0.01 BL differences: I-2 better educated;  I-1 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 serum lipids or weight at 6 months 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 
48  n = 82; F/U 6 months from BL; 56 years I-1: 11 × 2-h weekly didactic course + one individual session Decreased cholesterol all three groups at 3 months, maintained at 6 months No BL statistics comparing groups I more visits than C 
  I-2: 11-week course + three individual sessions: barriers and support Decreased weight at 3 months all three groups, P < 0.01, maintained at 6 months Attrition 40%, no comparison dropouts to completers Volunteer study population 
  C: Usual care NSD between groups; average loss 10 lb at 6 months  
59  n = 60; F/U 3 months from BL; 55 years I: Three-day group education, with F/U of four TC and one home visit; reinforce knowledge and skills NSD weight 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 m; by lay HCW C: Wait listed for the intervention Decreased weight at 6 months (4 lb in I); back to BL at 12 months 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; NSD weight between I and C No information on attrition Volunteer study population; 
  I-2: Behavioral strategies to increase compliance  F/U interval unclear Number of patient contacts unclear 
  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 
98  n = 22; F/U 32 weeks from BL; 61 years I: Weekly to biweekly home visits; nutrition, exercise, foot care, SMBG; by nursing students C: Usual care NSD weight between groups 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 LDL, total cholesterol at immediate F/U, P < 0.05; NSD 6 months Decreased weight at 6-month I (−8 lb), P = 0.02; 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 NSD BMI 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 C: Individual education on weight loss by dietitian; 3 or more visits in 12 months Decreased weight I (5.5 kg) and C (3 kg) at 1 year, between group difference, P < 0.05 
38  n = 32; F/U immediate, 1 year; 53 years I: Two sessions: dietician and CAI C: 2 × 30-min sessions: dietitian only Teaching for both over  approximately 1 month Decreased weight I (4.6 lb, P < 0.005), maintained at 1 year, NSD C No BL statistics Unclear if blinding assessor Type of DM uncertain 
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 NSD weight 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 
49  n = 41; F/U 6 months; 61 years I: Psychologist-led group sessions on PA and diet NSD % overweight Dropouts (22%) 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  Low participation rate, no information on nonparticipants 
66  n = 148; F/U 6 months from BL; 55 years I: Advice to decrease fat <30% total calorie intake Obese patients decreased weight I > C, P < 0.05 
  C: Advice to decrease CHO to <40% total calorie intake Decreased cholesterol in both groups I > C, P < 0.001 
  Both I and C received individual counseling by dietitian, three home visits NSD HDL or triglycerides 
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 Decreased cholesterol for I vs. C at 12 months, P = 0.002NSD BMI 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 Increased HDL I at 15 months, P < 0.001, NSD 27 months Weight loss I (3.1 kg) > C at 15 months, P = 0.022; NSD from BL at 27 months NSD BP 15 months I more visits than C No mention blinding assessor No information on nonparticipants 
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 weight, BP, cholesterol I more contact than C 
  C: Review session × 3 
71  n = 60; F/U 12 weeks from BL; 55 years I: Individualized advice on low glycemic index foods C: Standard, individualized diet advice NSD weight either group Decreased cholesterol I vs. C, P < 0.05 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 Decreased weight for I-2 at 2 months, P < 0.05 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 weight F/U immediate or 6 months NSD BP Increased Vo2max 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: 10 weekly sessions: problem-solving, increased self efficacy, diet, and PA focus C: Wait listed for I Decreased weight for I at 3 months (6 lb), maintained at 6 months (4.5 lb, P < 0.002) Randomization blocked by medication I more visits than C Volunteer study population 
75  n = 66; F/U 4 months; 30–86 years I: 5 × 90-min weekly sessions by nurse: diet, PA, barriers, social and group support NSD BMI 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-h biweekly participatory sessions; based on social action theory Decreased weight I at 3 and 6 months (−1.3 kg), P < 0.01 NSD SBP; decreased DBP 6 months, P < 0.05 I more visits than C More C dropouts, no comparison  dropouts to completers Volunteer study population 
  C: One didactic class and two mailings NSD lipids  
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 weight I-1 at 16 weeks (−6.3 kg), between group, P < 0.01 I more visits than C Volunteer study population 
  I-2: 16 weekly didactic sessions: nutrition and PA C: Four monthly didactic sessions Decreased weight all groups at 16 months, average change −2.8 kg, NSD between groups  
78,97  n = 79; F/U immediate; 68 years I-1: 10 × 60-min diet education sessions over 4 months; adapted for elderly Decreased weight I-2 at 8 weeks (5.5 lb, P < 0.05), NS gain to 16 weeks, NSD between groups 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 weight I-1 at 3 months (between group difference 3.9 kg, P < 0.03), and 6 months (4.5 kg, P < 0.02); NSD from BL at 18 months Decreased LDL I-1, P < 0.05 and I-3, P < 0.01 vs. C at 6 months Increased HDL I-1 vs. other groups, P < 0.05 at 3 months; NSD 6 months 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 % ideal body weight for I at 5 months, P < 0.05 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 total cholesterol I at 6 months, P < 0.05;NSD C NSD HDL or LDL I or C Decreased weight I and C, P < 0.01 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 NSD BMI between group with choice and no choice 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 Decreased cholesterol in I, between group difference, P = 0.04 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 weight females at immediate F/U, P = 0.0061 (amount of loss uncertain) No BL statistics I more visits than C Attrition 47%, but dropouts equivalent to 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 weight both groups, NSD between groups No BL statistics 
  C: Physician gave handout at initial  visit on weight loss Both I and C 6 visits/12 months NSD lipids or BP  
91  n = 120; F/U 7, 11 months from BL; 54 years I-1: Six monthly small-group meetings, diet and PA; audiovisual materials culturally sensitive Decreased weight I-1 at 7 months, (1 kg) P < 0.05, not sustained at 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 NSD triglycerides or cholesterol  
  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 C: Individual diet counseling, total 1.25 h Decreased weight C > I at 6 weeks, P < 0.01 Decreased triglycerides C at 12 weeks, P < 0.05 NSD LDL and HDL I more visits than C Unclear how patients selected 
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 Decreased BMI both groups; NSD between groups Decreased cholesterol I at 6 months, between group, P = 0.003 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); five classes/day for 5 days; diet focus Decreased % overweight I vs. C at 6 months, P < 0.01 Randomized by week of admission No BL statistics No mention blinding assessor Patients selected by physicians 
  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   
95  n = 120; 12 months from BL; 61 years I: Group education (diet, PA, BS control) q3 months × 4 C: Usual care Decreased weight, BMI I and C; NSD between groups I more contact than C Unclear if study population represents target population 
     
107  n = 152; F/U 10, 14 weeks from BL; 61 years I: 10 × 2-h sessions over 14 weeks, culturally sensitive video; nutrition focus C: No intervention Decreased weight I and C males at 14 weeks (2 kg) 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 
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 weight both I and C (6.0 kg end course, 3.7 kg at 1 y); NSD between groups No mention blinding assessor Volunteer study population 
64  n = 203; F/U 13 months I, 9 months C; ?age I: 1-h didactic group education on foot care NSD mortality Randomized on SSN No information on dropouts 
  C: No education  No mention blinding assessor 
    No information on nonparticipants Type of DM unclear 
90  n = 50; F/U 1 year from BL; 54 years I: Focused on relationship weight loss and BS control; monetary incentives C: Weight loss program Both groups: 12 weekly meetings, then monthly ×6, F/U in 3 months; behavioral weight control program Decreased weight I and C at 1 year (6.1 kg), NSD between groups Decreased SBP both I and C at 1 year; NSD between groups NSD cholesterol and HDL; decreased triglycerides both I and C Volunteer study population 
5. Coping skills and interventions 
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 Decreased weight (8 lb in men, 0.1 in women) at 18 months, I-1 > I-2,3 and C 
  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   
Referencen, F/U interval, and mean ageInterventionsOutcomesComments
1. Didactic, knowledge, and information interventions 
34  n = 345; F/U immediate; 58 years I: Nine multimedia education classes over 1.5 years C: Usual care NSD BP, weight, lipids No mention blinding assessor Low participation rate; nonparticipants older, more male 
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 C: Visit with doctor q2 months Decreased weight 2 kg in I vs. C, P < 0.05 NSD cholesterol, triglycerides between groups I more visits than C No information on participation rates 
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 NSD myocardial infarctions, ischemic heart disease, mortality; NSD BMI Increased cholesterol in all groups, NSD between groups No mention blinding assessor Low participation rate, no information on nonparticipants Clofibric acid arm double-blinded 
2. Collaborative, knowledge, and information interventions 
27,28  n = 532; F/U 12–14; 57 years I: Average 2.4 sessions × 1.5 h over 2 months + home visit, TC F/U, contracting, skill exercises, goal-setting; over 26 months C: Usual care Decreased SBP, DBP, between group difference, P < 0.05 Decreased weight I, between group difference 2.8 lb, P < 0.05 I more contact than C Attrition 51%, differences dropouts  and completers No blinding assessor Low participation rate 
29  n = 238; F/U 3, 6, 12 months from BL; 56 years I-1: 13 individual sessions in 12 months I-2: Three-day group interactive course + F/U 3 and 9 months + two individual sessions I-3: Six or more individual sessions based on cognitive behavior theory, TC F/U over 12 months C: 2 × 1-h group education NSD SBP, total cholesterol and BMI Decreased DBP I-3 vs. C at 12  months, P < 0.01 BL differences: I-2 better educated;  I-1 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 serum lipids or weight at 6 months 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 
48  n = 82; F/U 6 months from BL; 56 years I-1: 11 × 2-h weekly didactic course + one individual session Decreased cholesterol all three groups at 3 months, maintained at 6 months No BL statistics comparing groups I more visits than C 
  I-2: 11-week course + three individual sessions: barriers and support Decreased weight at 3 months all three groups, P < 0.01, maintained at 6 months Attrition 40%, no comparison dropouts to completers Volunteer study population 
  C: Usual care NSD between groups; average loss 10 lb at 6 months  
59  n = 60; F/U 3 months from BL; 55 years I: Three-day group education, with F/U of four TC and one home visit; reinforce knowledge and skills NSD weight 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 m; by lay HCW C: Wait listed for the intervention Decreased weight at 6 months (4 lb in I); back to BL at 12 months 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; NSD weight between I and C No information on attrition Volunteer study population; 
  I-2: Behavioral strategies to increase compliance  F/U interval unclear Number of patient contacts unclear 
  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 
98  n = 22; F/U 32 weeks from BL; 61 years I: Weekly to biweekly home visits; nutrition, exercise, foot care, SMBG; by nursing students C: Usual care NSD weight between groups 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 LDL, total cholesterol at immediate F/U, P < 0.05; NSD 6 months Decreased weight at 6-month I (−8 lb), P = 0.02; 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 NSD BMI 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 C: Individual education on weight loss by dietitian; 3 or more visits in 12 months Decreased weight I (5.5 kg) and C (3 kg) at 1 year, between group difference, P < 0.05 
38  n = 32; F/U immediate, 1 year; 53 years I: Two sessions: dietician and CAI C: 2 × 30-min sessions: dietitian only Teaching for both over  approximately 1 month Decreased weight I (4.6 lb, P < 0.005), maintained at 1 year, NSD C No BL statistics Unclear if blinding assessor Type of DM uncertain 
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 NSD weight 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 
49  n = 41; F/U 6 months; 61 years I: Psychologist-led group sessions on PA and diet NSD % overweight Dropouts (22%) 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  Low participation rate, no information on nonparticipants 
66  n = 148; F/U 6 months from BL; 55 years I: Advice to decrease fat <30% total calorie intake Obese patients decreased weight I > C, P < 0.05 
  C: Advice to decrease CHO to <40% total calorie intake Decreased cholesterol in both groups I > C, P < 0.001 
  Both I and C received individual counseling by dietitian, three home visits NSD HDL or triglycerides 
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 Decreased cholesterol for I vs. C at 12 months, P = 0.002NSD BMI 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 Increased HDL I at 15 months, P < 0.001, NSD 27 months Weight loss I (3.1 kg) > C at 15 months, P = 0.022; NSD from BL at 27 months NSD BP 15 months I more visits than C No mention blinding assessor No information on nonparticipants 
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 weight, BP, cholesterol I more contact than C 
  C: Review session × 3 
71  n = 60; F/U 12 weeks from BL; 55 years I: Individualized advice on low glycemic index foods C: Standard, individualized diet advice NSD weight either group Decreased cholesterol I vs. C, P < 0.05 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 Decreased weight for I-2 at 2 months, P < 0.05 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 weight F/U immediate or 6 months NSD BP Increased Vo2max 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: 10 weekly sessions: problem-solving, increased self efficacy, diet, and PA focus C: Wait listed for I Decreased weight for I at 3 months (6 lb), maintained at 6 months (4.5 lb, P < 0.002) Randomization blocked by medication I more visits than C Volunteer study population 
75  n = 66; F/U 4 months; 30–86 years I: 5 × 90-min weekly sessions by nurse: diet, PA, barriers, social and group support NSD BMI 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-h biweekly participatory sessions; based on social action theory Decreased weight I at 3 and 6 months (−1.3 kg), P < 0.01 NSD SBP; decreased DBP 6 months, P < 0.05 I more visits than C More C dropouts, no comparison  dropouts to completers Volunteer study population 
  C: One didactic class and two mailings NSD lipids  
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 weight I-1 at 16 weeks (−6.3 kg), between group, P < 0.01 I more visits than C Volunteer study population 
  I-2: 16 weekly didactic sessions: nutrition and PA C: Four monthly didactic sessions Decreased weight all groups at 16 months, average change −2.8 kg, NSD between groups  
78,97  n = 79; F/U immediate; 68 years I-1: 10 × 60-min diet education sessions over 4 months; adapted for elderly Decreased weight I-2 at 8 weeks (5.5 lb, P < 0.05), NS gain to 16 weeks, NSD between groups 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 weight I-1 at 3 months (between group difference 3.9 kg, P < 0.03), and 6 months (4.5 kg, P < 0.02); NSD from BL at 18 months Decreased LDL I-1, P < 0.05 and I-3, P < 0.01 vs. C at 6 months Increased HDL I-1 vs. other groups, P < 0.05 at 3 months; NSD 6 months 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 % ideal body weight for I at 5 months, P < 0.05 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 total cholesterol I at 6 months, P < 0.05;NSD C NSD HDL or LDL I or C Decreased weight I and C, P < 0.01 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 NSD BMI between group with choice and no choice 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 Decreased cholesterol in I, between group difference, P = 0.04 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 weight females at immediate F/U, P = 0.0061 (amount of loss uncertain) No BL statistics I more visits than C Attrition 47%, but dropouts equivalent to 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 weight both groups, NSD between groups No BL statistics 
  C: Physician gave handout at initial  visit on weight loss Both I and C 6 visits/12 months NSD lipids or BP  
91  n = 120; F/U 7, 11 months from BL; 54 years I-1: Six monthly small-group meetings, diet and PA; audiovisual materials culturally sensitive Decreased weight I-1 at 7 months, (1 kg) P < 0.05, not sustained at 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 NSD triglycerides or cholesterol  
  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 C: Individual diet counseling, total 1.25 h Decreased weight C > I at 6 weeks, P < 0.01 Decreased triglycerides C at 12 weeks, P < 0.05 NSD LDL and HDL I more visits than C Unclear how patients selected 
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 Decreased BMI both groups; NSD between groups Decreased cholesterol I at 6 months, between group, P = 0.003 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); five classes/day for 5 days; diet focus Decreased % overweight I vs. C at 6 months, P < 0.01 Randomized by week of admission No BL statistics No mention blinding assessor Patients selected by physicians 
  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   
95  n = 120; 12 months from BL; 61 years I: Group education (diet, PA, BS control) q3 months × 4 C: Usual care Decreased weight, BMI I and C; NSD between groups I more contact than C Unclear if study population represents target population 
     
107  n = 152; F/U 10, 14 weeks from BL; 61 years I: 10 × 2-h sessions over 14 weeks, culturally sensitive video; nutrition focus C: No intervention Decreased weight I and C males at 14 weeks (2 kg) 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 
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 weight both I and C (6.0 kg end course, 3.7 kg at 1 y); NSD between groups No mention blinding assessor Volunteer study population 
64  n = 203; F/U 13 months I, 9 months C; ?age I: 1-h didactic group education on foot care NSD mortality Randomized on SSN No information on dropouts 
  C: No education  No mention blinding assessor 
    No information on nonparticipants Type of DM unclear 
90  n = 50; F/U 1 year from BL; 54 years I: Focused on relationship weight loss and BS control; monetary incentives C: Weight loss program Both groups: 12 weekly meetings, then monthly ×6, F/U in 3 months; behavioral weight control program Decreased weight I and C at 1 year (6.1 kg), NSD between groups Decreased SBP both I and C at 1 year; NSD between groups NSD cholesterol and HDL; decreased triglycerides both I and C Volunteer study population 
5. Coping skills and interventions 
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 Decreased weight (8 lb in men, 0.1 in women) at 18 months, I-1 > I-2,3 and C 
  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.

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