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Table 6 —

Effect of self-management training on economic and health care utilization outcomes

Referencen, F/U interval, and mean ageInterventionsOutcomesReordered comments
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 sick days, admissions, emergency room or OP visits No mention blinding assessor Low participation rate; nonparticipants older, more male 
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 More sick leave events/year for C vs. I, P < 0.05 NSD duration sick leave events No mention blinding assessor Low participation rates, no information on nonparticipants Clofibric acid arm double-blinded 
2. Collaborative, knowledge, and information interventions 
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 by fellow patients C: No intervention I based on Fishbein and Ajzen Health Belief Model NSD quality of life NSD sick days, use of health services, daily insulin dosage, number injections Cost per intervention patient (including indirect costs): $100 Hospitals randomized I more visits than C Uncertain blinding assessor 
46  n = 471; F/U 6, 12 months from BL; 52 years I: Home visits, teaching based on needs assessment, maximum 12 visits C: Usual care NSD emergency room and physician visits, hospitalizations, length of stay, DM-related sick days at 1 year Attrition 20%; no comparison dropouts to completers 70% of eligible participated 
     
54  n = 107; F/U 1, 4 months; 60 years I: 2 × 2-h group didactic + practice + feedback + usual care Decreased emergency room visits for I vs. C, P = 0.005 Randomized by hospital number No blinding assessor 
  C: Usual care: individual education based on perceived patient need  No information on participation rates 
  Both in IP setting 
3. Lifestyle interventions 
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 Direct costs of intervention $137 per patient NSD quality of life Unclear if food record reviewers were blinded Low participation rate; participants differ from nonparticipants 
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 Increased quality of life for I-3 at 18 months, P < 0.05 Randomized by group meeting attended Volunteer study population 
81,102  n = 203; 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 Cost per % change GHb lower for C; no statistics Cost effectiveness ratio $56.26 per % change in HbA1c Nonrandomized C-2 C less time with dietitian Attrition 28% for lab studies, unclear if lab dropouts equal completers at BL Volunteer study population or physician-referred 
Referencen, F/U interval, and mean ageInterventionsOutcomesReordered comments
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 sick days, admissions, emergency room or OP visits No mention blinding assessor Low participation rate; nonparticipants older, more male 
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 More sick leave events/year for C vs. I, P < 0.05 NSD duration sick leave events No mention blinding assessor Low participation rates, no information on nonparticipants Clofibric acid arm double-blinded 
2. Collaborative, knowledge, and information interventions 
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 by fellow patients C: No intervention I based on Fishbein and Ajzen Health Belief Model NSD quality of life NSD sick days, use of health services, daily insulin dosage, number injections Cost per intervention patient (including indirect costs): $100 Hospitals randomized I more visits than C Uncertain blinding assessor 
46  n = 471; F/U 6, 12 months from BL; 52 years I: Home visits, teaching based on needs assessment, maximum 12 visits C: Usual care NSD emergency room and physician visits, hospitalizations, length of stay, DM-related sick days at 1 year Attrition 20%; no comparison dropouts to completers 70% of eligible participated 
     
54  n = 107; F/U 1, 4 months; 60 years I: 2 × 2-h group didactic + practice + feedback + usual care Decreased emergency room visits for I vs. C, P = 0.005 Randomized by hospital number No blinding assessor 
  C: Usual care: individual education based on perceived patient need  No information on participation rates 
  Both in IP setting 
3. Lifestyle interventions 
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 Direct costs of intervention $137 per patient NSD quality of life Unclear if food record reviewers were blinded Low participation rate; participants differ from nonparticipants 
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 Increased quality of life for I-3 at 18 months, P < 0.05 Randomized by group meeting attended Volunteer study population 
81,102  n = 203; 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 Cost per % change GHb lower for C; no statistics Cost effectiveness ratio $56.26 per % change in HbA1c Nonrandomized C-2 C less time with dietitian Attrition 28% for lab studies, unclear if lab dropouts equal completers at BL Volunteer study population or physician-referred 

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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