Self-Management Interventions for Adults Living with Type II Diabetes to Improve Patient-Important Outcomes: An Evidence Map
-
Published:2023-12-13
Issue:24
Volume:11
Page:3156
-
ISSN:2227-9032
-
Container-title:Healthcare
-
language:en
-
Short-container-title:Healthcare
Author:
Song Yang1, Beltran Puerta Jessica1, Medina-Aedo Melixa1ORCID, Canelo-Aybar Carlos1, Valli Claudia123ORCID, Ballester Marta234, Rocha Claudio1ORCID, Garcia Montserrat León1ORCID, Salas-Gama Karla1, Kaloteraki Chrysoula1ORCID, Santero Marilina1ORCID, Niño de Guzmán Ena1ORCID, Spoiala Cristina5, Gurung Pema5, Willemen Fabienne5, Cools Iza5ORCID, Bleeker Julia5, Poortvliet Rune5, Laure Tajda5, Gaag Marieke van der5, Pacheco-Barrios Kevin2, Zafra-Tanaka Jessica2ORCID, Mavridis Dimitris6ORCID, Angeliki Veroniki Areti78, Zevgiti Stella6, Seitidis Georgios6ORCID, Alonso-Coello Pablo19ORCID, Groene Oliver1011ORCID, González-González Ana Isabel234, Sunol Rosa234, Orrego Carola234ORCID, Heijmans Monique5ORCID
Affiliation:
1. Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain 2. Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain 3. Faculty of Medicine, Universitat Autὸnoma de Barcelona (UAB), 08025 Barcelona, Spain 4. Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain 5. Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands 6. Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece 7. Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada 8. Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5S 3G8, Canada 9. Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain 10. OptiMedis, 20095 Hamburg, Germany 11. Faculty of Management, Economics and Society, University of Witten/Herdecke, 58455 Witten, Germany
Abstract
Self-management interventions (SMIs) may be promising in the treatment of Diabetes Mellitus Type 2 (T2DM). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study summarizes intervention components and characteristics in randomized controlled trials (RCTs) related to T2DM using a taxonomy for SMIs as a framework and identifies components that are insufficiently incorporated into the design of the intervention or insufficiently reported. Following evidence mapping methodology, we searched MEDLINE, CINAHL, Embase, Cochrane, and PsycINFO from 2010 to 2018 for randomized controlled trials (RCTs) on SMIs for T2DM. We used the terms ‘self-management’, ‘adult’ and ‘T2DM’ for content. For data extraction, we used an online platform based on the taxonomy for SMIs. Two independent reviewers assessed eligible references; one reviewer extracted data, and a second checked accuracy. We identified 665 RCTs for SMIs (34% US, 21% Europe) including 164,437 (median 123, range 10–14,559) adults with T2DM. SMIs highly differed in design and content, and characteristics such as mode of delivery, intensity, location and providers involved were poorly described. The majority of interventions aimed to improve clinical outcomes like HbA1c (83%), weight (53%), lipid profile (45%) or blood pressure (42%); 27% (also) targeted quality of life. Improved knowledge, health literacy, patient activation or satisfaction with care were hardly used as outcomes (<16%). SMIs most often used education (98%), self-monitoring (56%), goal-setting (48%) and skills training (42%) to improve outcomes. Management of emotions (17%) and shared decision-making (5%) were almost never mentioned. Although diabetes is highly prevalent in some minority groups, in only 13% of the SMIs, these groups were included. Our findings highlight the large heterogeneity that exists in the design of SMIs for T2DM and the way studies are reported, making accurate comparisons of their relative effectiveness challenging. In addition, SMIs pay limited attention to outcomes other than clinical, despite the importance attached to these outcomes by patients. More standardized and streamlined research is needed to better understand the effectiveness and cost-effectiveness of SMIs of T2DM and benefit patient care.
Funder
European Union’s Horizon 2020 research and innovation program
Subject
Health Information Management,Health Informatics,Health Policy,Leadership and Management
Reference32 articles.
1. WHO (2013). Global Action Plan for the Prevention and Control of NCDs 2013–2020, World Health Organization. 2. Global, regional, and national burden and trend of diabetes in 195 countries and territories: An analysis from 1990 to 2025;Lin;Sci. Rep.,2020 3. Glasgow, R.E., and Eakin, E.G. (1998). Issues in Diabetes Self-Management. The Handbook of Health Behavior Change, Springer Publishing Company. [2nd ed.]. 4. Psychosocial problems and barriers to improved diabetes management: Results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study;Peyrot;Diabet. Med.,2005 5. Self-management programmes for COPD: Moving forward;Effing;Chron. Respir. Dis.,2012
|
|