Review article
Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control

https://doi.org/10.1016/j.pec.2015.11.003Get rights and content
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Highlights

  • DSME appears most effective when group and individualized intervention are combined (74).

  • DSME appears most effective delivered by a team rather than single provider (65).

  • People in poor glycemic control benefit from participation in quality DSME (65).

  • More than 10 hours of DSME increases the likelihood of resulting in significant A1C improvement (84).

  • Time period over which DSME is delivered does not affect its impact on A1C (62).

Abstract

Objective

Assess effect of diabetes self-management education and support methods, providers, duration, and contact time on glycemic control in adults with type 2 diabetes.

Method

We searched MEDLINE, CINAHL, EMBASE, ERIC, and PsycINFO to December 2013 for interventions which included elements to improve participants’ knowledge, skills, and ability to perform self-management activities as well as informed decision-making around goal setting.

Results

This review included 118 unique interventions, with 61.9% reporting significant changes in A1C. Overall mean reduction in A1C was 0.74 and 0.17 for intervention and control groups; an average absolute reduction in A1C of 0.57. A combination of group and individual engagement results in the largest decreases in A1C (0.88). Contact hours ≥10 were associated with a greater proportion of interventions with significant reduction in A1C (70.3%). In patients with persistently elevated glycemic values (A1C > 9), a greater proportion of studies reported statistically significant reduction in A1C (83.9%).

Conclusions

This systematic review found robust data demonstrating that engagement in diabetes self-management education results in a statistically significant decrease in A1C levels.

Practice implications

The data suggest mode of delivery, hours of engagement, and baseline A1C can affect the likelihood of achieving statistically significant and clinically meaningful improvement in A1C.

Keywords

Type 2 diabetes
Diabetes self-management education
Glycemic
Control
Systematic review

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