J Diabetes Metab Disord. 2021 Jul 15;20(2):1815-1836. doi: 10.1007/s40200-021-00846-8. eCollection 2021 Dec.
Behavior change interventions in patients with type 2 diabetes: a systematic review of the effects on self-management and A1c.
Journal of diabetes and metabolic disorders
Ana Paula Delgado Bomtempo Batalha, Isabela Coelho Ponciano, Gabriela Chaves, Diogo Carvalho Felício, Raquel Rodrigues Britto, Lilian Pinto da Silva
Affiliations
Affiliations
- Graduate Program in Rehabilitation and Physical-Functional Performance Sciences, Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil.
- Myant Inc., Toronto, ON Canada.
- Faculty of Physical Therapy, UFJF, Juiz de Fora, MG Brazil.
- Graduate Program in Rehabilitation Science, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil.
- Cardiovascular Research and Exercise Physiology Unit, University Hospital, UFJF, Juiz de Fora, MG Brazil.
- Faculty of Physiotherapy, Federal University of Juiz de Fora, Av. Eugenio do Nascimento S/N Bairro Dom Bosco, Juiz de Fora, MG CEP: 36038-330 Brazil.
PMID: 34900827
PMCID: PMC8630317 DOI: 10.1007/s40200-021-00846-8
Abstract
PURPOSE: This study aimed to identify the characteristics of interventions employed to promote behavior change in people with type 2 diabetes mellitus (T2DM) and their impact on disease self-management and glycated hemoglobin (A1c).
METHODS: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to guide the protocol development for this systematic review. Randomized controlled clinical trials which compared behavior change interventions to controls in adults with T2DM and investigated disease self-management and glycated hemoglobin (A1c) measured by validated methods were eligible for this study. The risk of bias and quality of evidence was assessed respectively by Cochrane's tool and grading of recommendations, assessment, development, and evaluation (GRADE).
RESULTS: A total of 27 studies were included involving 4464 participants. Behavior change was mainly promoted by education sessions on diabetes care delivered face-to-face, monthly, or every other month, lasting more than 60 min, involving blood glucose monitoring, healthy eating, exercise, and medication. Four studies showed significant improvement in both disease self-management and A1c. The risk of bias was classified as high in most studies. A meta-analysis could not be performed for A1c and self-management due to the high differences in intervention parameters (delivery mode, number, duration, and frequency) and self-management assessments.
CONCLUSION: Low evidence of improvement in disease self-management and A1c considering only validated assessment methods were found for behavior change interventions, mainly promoted by education sessions on diabetes care. The quality of studies and probably the differences in intervention protocols contributed to this finding.
PROSPERO NUMBER: CRD42020161162.
© Springer Nature Switzerland AG 2021.
Keywords: Diabetes mellitus type 2; Glycated hemoglobin A; Self-management; Self-management behaviors
Conflict of interest statement
Conflict of interestOn behalf of all authors, the corresponding author states that there are no conflicts of interest.
References
- World J Diabetes. 2021 Feb 15;12(2):170-197 - PubMed
- Patient Educ Couns. 2016 Jun;99(6):926-43 - PubMed
- Ann Pharmacother. 2009 May;43(5):882-9 - PubMed
- J Behav Med. 2009 Aug;32(4):349-59 - PubMed
- Arch Gerontol Geriatr. 2015 Jan-Feb;60(1):82-8 - PubMed
- Int J Nurs Pract. 2008 Oct;14(5):373-82 - PubMed
- Malays Fam Physician. 2012 Aug 31;7(2-3):10-20 - PubMed
- N Engl J Med. 1993 Sep 30;329(14):977-86 - PubMed
- Postgrad Med J. 2011 Oct;87(1032):688-93 - PubMed
- Diabetes Educ. 2010 Jul-Aug;36(4):629-39 - PubMed
- Age Ageing. 2009 Jul;38(4):390-6 - PubMed
- J Diabetes Sci Technol. 2017 Sep;11(5):1015-1027 - PubMed
- Ann Behav Med. 2013 Feb;45(1):24-32 - PubMed
- BMJ Open. 2015 Jun 25;5(6):e007014 - PubMed
- Int J Clin Pharm. 2018 Apr;40(2):345-353 - PubMed
- Best Pract Res Clin Rheumatol. 2001 Oct;15(4):545-58 - PubMed
- Diabet Med. 2017 Aug;34(8):1027-1039 - PubMed
- Ann Behav Med. 2010 Aug;40(1):49-64 - PubMed
- Diabetes Care. 2000 Jul;23(7):943-50 - PubMed
- Diabetes Care. 2009 Apr;32(4):559-66 - PubMed
- Diabetol Metab Syndr. 2018 Sep 3;10:67 - PubMed
- Diabetes Care. 2006 Apr;29(4):823-9 - PubMed
- BMC Public Health. 2017 Jan 6;17(1):41 - PubMed
- BMJ. 2015 Jan 02;350:g7647 - PubMed
- Clinics (Sao Paulo). 2015 Feb;70(2):102-6 - PubMed
- Nurs Open. 2019 Sep 03;6(4):1424-1437 - PubMed
- Arch Intern Med. 2011 Dec 12;171(22):2001-10 - PubMed
- Diabetes Care. 2010 Aug;33(8):1903-4 - PubMed
- J Diabetes Metab Disord. 2018 Nov 27;17(2):365-380 - PubMed
- Diabetes Care. 2012 Dec;35(12):2681-9 - PubMed
- Diabetes Res Clin Pract. 2017 Jan;123:37-48 - PubMed
- Glob Health Promot. 2013 Jun;20(2 Suppl):94-8 - PubMed
- Diabetes Educ. 2017 Jun;43(3):272-285 - PubMed
- BMJ Open. 2019 Jul 16;9(7):e027775 - PubMed
- Eval Health Prof. 2016 Jun;39(2):131-84 - PubMed
- Patient Educ Couns. 2020 Feb;103(2):266-275 - PubMed
- J Diabetes Metab Disord. 2020 Jul 11;19(2):1631-1637 - PubMed
- J Eval Clin Pract. 2017 Aug;23(4):821-829 - PubMed
- Diabetes Metab Syndr Obes. 2020 Jan 13;13:117-138 - PubMed
- N Engl J Med. 2004 Sep 16;351(12):1250-1 - PubMed
- Patient Educ Couns. 2012 Jan;86(1):98-105 - PubMed
- Diabetes Educ. 2009 Jul-Aug;35(4):641-51 - PubMed
- Ann Emerg Med. 2014 Jun;63(6):745-54.e6 - PubMed
- Phys Ther. 2008 Nov;88(11):1254-64 - PubMed
- Diabetes Educ. 2011 Nov-Dec;37(6):801-12 - PubMed
- Health Serv Res. 2005 Dec;40(6 Pt 1):1918-30 - PubMed
- Diabetes Care. 2013 Jul;36(7):1954-60 - PubMed
- BMC Health Serv Res. 2018 May 16;18(1):367 - PubMed
- Patient Educ Couns. 2016 Aug;99(8):1382-8 - PubMed
- Patient Prefer Adherence. 2018 Nov 21;12:2457-2474 - PubMed
- Curr Diabetes Rev. 2015;12(2):120-8 - PubMed
- J Adv Nurs. 1999 Aug;30(2):352-9 - PubMed
- Diabetes Care. 2017 Oct;40(10):1409-1419 - PubMed
- Prim Care Diabetes. 2016 Aug;10(4):251-8 - PubMed
- Chronic Illn. 2006 Mar;2(1):27-38 - PubMed
- Am J Public Health. 2018 Sep;108(9):1227-1234 - PubMed
- J Manag Care Spec Pharm. 2017 May;23(5):573-582 - PubMed
- Prim Care Diabetes. 2019 Apr;13(2):122-133 - PubMed
- Ann Intern Med. 2013 Oct 15;159(8):543-51 - PubMed
- J Pak Med Assoc. 2019 Mar;69(3):294-300 - PubMed
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