Conclusions of a review of randomized, controlled trials of the effectiveness of self-management training in type 2 diabetes
| A. Effectiveness of interventions | |
| 1. In the short term (<6 months), knowledge levels, SMBG skills, and self-reported dietary habits improve. | |
| 2. In the short term, improvements in glycemic control, knowledge, and diet are more readily demonstrated than improvements in weight and physical activity levels. | |
| 3. Improved glycemic control does not correspond to measured changes in knowledge or SMBG skills. | |
| 4. Weight loss can be demonstrated with repetitive interventions or with short-term follow-up (<6 months). | |
| 5. Physical activity levels are variably affected by interventions. | |
| 6. Effects on lipids and blood pressure are variable and more likely to be positive with interactive or individualized, repetitive interventions. | |
| 7. Studies with short-term follow-up are more likely to demonstrate positive effects on glycemic control and behavioral outcomes than studies with longer follow-up intervals. | |
| 8. Interventions with regular reinforcement are more effective than one-time or short-term education. | |
| 9. Interventions that involve patient participation and collaboration seem to produce somewhat more favorable effects on glycemic control, weight loss, and lipid profiles than didactic ones. | |
| 10. Group education is more effective for lifestyle interventions and seems to be equally effective for interventions focusing on knowledge and SMBG. | |
| 11. The focus of the current literature has been on knowledge and glycemic control outcomes; there is little literature measuring quality of life and long-term clinical outcomes. | |
| B. Methodological issues | |
| 1. Descriptive information is frequently lacking, including type of diabetes and the representativeness of study populations to target populations. | |
| 2. Threats to internal validity (selection, performance, attrition, and detection bias) are common. | |
| 3. Generalizability of study results is often limited by enrollee or researcher selection into study populations or by lack of information on the representativeness of the study population. | |
| C. Potential future research topics | |
| 1. Systematic review of the effectiveness of self-management training interventions in patients with type 2 diabetes using study designs other than randomized, controlled trials. | |
| 2. Effectiveness studies to define optimal long-term and maintenance interventions with respect to content, frequency, and method of delivery. | |
| 3. Studies to further delineate the impact of self-management training on intermediate outcomes, such as self-efficacy, problem-solving, and coping skills, and to better define the relationship between these outcomes and behavior change, glycemic control, and long-term outcomes. | |
| 4. Studies examining the feasibility, effectiveness, and cost-effectiveness of population-based self-management training, as compared with individual patient-centered training. | |
| 5. Quantitative review of self-management training effectiveness to further examine the heterogeneity of the literature, and the relationships between population characteristics, study design and quality, intervention characteristics, and outcomes. | |
| 6. Effectiveness studies focusing on long-term cardiovascular, quality of life, and economic outcomes. | |
| A. Effectiveness of interventions | |
| 1. In the short term (<6 months), knowledge levels, SMBG skills, and self-reported dietary habits improve. | |
| 2. In the short term, improvements in glycemic control, knowledge, and diet are more readily demonstrated than improvements in weight and physical activity levels. | |
| 3. Improved glycemic control does not correspond to measured changes in knowledge or SMBG skills. | |
| 4. Weight loss can be demonstrated with repetitive interventions or with short-term follow-up (<6 months). | |
| 5. Physical activity levels are variably affected by interventions. | |
| 6. Effects on lipids and blood pressure are variable and more likely to be positive with interactive or individualized, repetitive interventions. | |
| 7. Studies with short-term follow-up are more likely to demonstrate positive effects on glycemic control and behavioral outcomes than studies with longer follow-up intervals. | |
| 8. Interventions with regular reinforcement are more effective than one-time or short-term education. | |
| 9. Interventions that involve patient participation and collaboration seem to produce somewhat more favorable effects on glycemic control, weight loss, and lipid profiles than didactic ones. | |
| 10. Group education is more effective for lifestyle interventions and seems to be equally effective for interventions focusing on knowledge and SMBG. | |
| 11. The focus of the current literature has been on knowledge and glycemic control outcomes; there is little literature measuring quality of life and long-term clinical outcomes. | |
| B. Methodological issues | |
| 1. Descriptive information is frequently lacking, including type of diabetes and the representativeness of study populations to target populations. | |
| 2. Threats to internal validity (selection, performance, attrition, and detection bias) are common. | |
| 3. Generalizability of study results is often limited by enrollee or researcher selection into study populations or by lack of information on the representativeness of the study population. | |
| C. Potential future research topics | |
| 1. Systematic review of the effectiveness of self-management training interventions in patients with type 2 diabetes using study designs other than randomized, controlled trials. | |
| 2. Effectiveness studies to define optimal long-term and maintenance interventions with respect to content, frequency, and method of delivery. | |
| 3. Studies to further delineate the impact of self-management training on intermediate outcomes, such as self-efficacy, problem-solving, and coping skills, and to better define the relationship between these outcomes and behavior change, glycemic control, and long-term outcomes. | |
| 4. Studies examining the feasibility, effectiveness, and cost-effectiveness of population-based self-management training, as compared with individual patient-centered training. | |
| 5. Quantitative review of self-management training effectiveness to further examine the heterogeneity of the literature, and the relationships between population characteristics, study design and quality, intervention characteristics, and outcomes. | |
| 6. Effectiveness studies focusing on long-term cardiovascular, quality of life, and economic outcomes. | |