Table 3 —

Effect of self-management training on lifestyle behaviors, psychological outcomes, and quality of life

Referencen, F/U interval, and mean ageInterventionsOutcomesComments
1. Didactic, knowledge, and information interventions
33n = 60; F/U immediate, 4 weeks; ?ageI: Four weekly group sessions: individual as needed C: Started same education 4 weeks laterDecreased anxiety at 4 weeks I vs. C, P < 0.05 NSD depression scoreNo BL statistics I more visits than C Attrition 29%, dropouts not equal completers at BL
Low participation rate, but NSD participants and nonparticipants
35n = 77; F/U 6 to 18 months from BL; 33 yearsI: Five days IP teaching: didactic, individual F/U q3 months, phone access; instruction in self-adjustment insulin C: Five days IP “traditional” education + written information; 3 × 1.5-h sessions; q3 months F/UNSD diet adherence at 18 monthsNo BL comparison statistics No attrition information No blinding for diet history Low recruitment rate and no information on nonparticipants
65,109n = 1,139; F/U 5 years; 46 yearsI-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 monthsIncreased polyunsaturated fats in I vs. C, P < 0.01 Increased PA in I vs. C, P < 0.01No mention blinding assessor Low participation rate, no information on nonparticipants Clofibric acid arm double-blinded
2. Collaborative, knowledge, and information interventions
30n = 46; F/U immediate, 6 months; 66 yearsI: 8 × 2-h small group sessions over 3 months; problem- and participant-focusedNSD exerciseI more visits than C More C excluded due to poor control No mention blinding assessor
C: One day didactic teachingNonparticipants older and heavier
40,60n = 558; F/U 6 months; 45 yearsI-1: Collaborative education by HCW, 3 h/week × 4 weeksNSD hypoglycemic reactions, anxiety, PAHospitals randomized I more visits than C
I-2: Same education, led by fellow patientUncertain blinding assessor
C: No intervention I based on Fishbein and Ajzen Health Belief Model
54n = 107; F/U 1, 4 months; 60 years1: 2 × 2-h group didactic + practice + feedback + usual careIncreased exercise I vs. C at 1 and 4 months, P = 0.05Randomized by hospital number No binding assessor
C: Usual care: individual education based on perceived patient need Both in IP settingNo information on participation rates
98n = 22; F/U 32 weeks from baseline; 61 yearsI: Weekly to biweekly home visits: nutrition, exercise, foot care, SMBG; by nursing students C: Usual careNSD food assessment, 3-day dietary recall, functional health status between groupsAttrition 24%, no comparison dropouts to completers No mention blinding assessor Unclear if study population represents target population
3. Lifestyle interventions
31n = 40; F/U 6 months from BL; 35 yearsI-1: Lunch demonstrations I-2: Videotape education C: Dietitian instruction and written information Three visits total for all groups over 6 monthsDecreased CHO variation in I-1 and I-2, P < 0.01No mention blinding assessor Study population selected by researchers; low participation rate Type of diabetes unclear (“insulin dependent”)
38n = 32; F/U immediate; 53 yearsI: Two sessions: dietitian and CAI C: 2 × 30-min sessions: only dietitian Teaching for both over approximately 1 monthDecreased % fat intake I, P < 0.005; NSD CNo BL statistics Unclear if blinding assessor Type of DM unclear
39n = 105; F/U immediate, 12 months; 45 yearsI: Interactive computer program on diet; 90 min/month over 6 months C: Wait listed for I Both groups received 5 days teachingDecreased caloric and fat intake for those in I with initial high intake, P < 0.05I more contact than C Attrition appears to be 76% at 12 months F/U, no comparison dropouts to completers
No mention blinding assessor No information on patient recruitment Crossover design
66n = 148; F/U 6 months from BL; 55 yearsI: Advice to decrease fat to <30% total calorie intake C: Advice to decreased CHO to <40% total calorie intake Both individual counseling by dietitian, three home visitsDecreased fat and cholesterol intake, increased CHO for I, between group difference, P < 0.001
67,68,104n = 206; F/U 12 months from BL; 62 yearsI: Single visit: focus on diet; goal-setting, interactive video on barriers; F/U q3 months C: Usual care q3 monthsImprovement in I vs. C at 12 months for food habits, 4-day food record, kcal/day, % calories from fat, P < 0.05Unclear if food record reviewers blinded Low participation rate; participants differ from nonparticipants
69,82,89,103n = 86; F/U 15, 27 months from BL; 53 yearsI: Six individual visits at 2-month intervals: intensive therapy for weight, BS control, diet, PA; then q3 months visits C: Usual care q2–3 monthsFat intake <30% of total energy, I > C at 15 months, P < 0.05 NSD energy intake NSD physical activity, Vo2max at 15 monthsI more visits than C No mention blinding assessor No information on nonparticipants
Both groups got 3 visits/3 months basic education before randomization
70n = 75; F/U 12 months from BL; 61 yearsI: Educational videos, personal and family support q2 weeks for 6 months + 3 h counseling by dietitian C: Review session × 3Decreased self-reported fat intake, P = 0.0002 NSD self-reported total food or fiber intakeI more contact than C
71n = 60; F/U 12 weeks from BL; 55 yearsI: Individualized advice on low glycemic index foods C: Standard, individualized diet adviceConsumption of lower glycemic index foods I > C, P < 0.01No mention blinding assessor Unclear how much intervention time
72n = 78; F/U 2 months; 42–75 yearsI-1: 5 × 2-h weekly education: calories, fat, fiber I-2: I-1 + goal setting, problem-solving, feedback C: Wait listed for IDecreased calories and % fat F/U for I-2 at immediate and 2 months, P < 0.01 Decreased calories for I-1 at 2 months, P < 0.05No BL information I more visits than C More attrition in C, no comparison dropouts to completers Unclear if assessor blinded Unclear how study population recruited
73n = 70 F/U immediate 6 months; 42 yearsI: Monthly (or more) meetings: diet and PA prescription, feedback, behavior modification C: Usual care, wait listed for IDecreased total fat intake at immediate F/U, I vs. C, P = 0.047 Deterioration of diet improvements at 6 monthsIncomplete BL statistics I more visits than C No mention blinding assessor Volunteer study population; cross-over design Type of DM uncertain (“IDDM”)
74n = 102; F/U 3, 6 months from BL; 67 yearsI: Ten weekly sessions: problem-solving, increased self-efficacy; diet and PA focus C: Wait listed for IIncreased problem-solving for I at 3 and 6 months; between group, P < 0.05Randomization blocked by medication I more visits than C Volunteer study population
75n = 66; F/U 4 months; 30–86 yearsI: Five × 90-min weekly sessions by nurse: diet and PA, barriers, social and group supportImproved health practices (diet, PA) I vs. C, P = 0.015No BL statistics Volunteer study population Number of visits uncertain
C: No information on care received
76n = 64; F/U 3, 6 months from BL; 62 yearsI: 12 × 1.5-h weekly (didactic) sessions, then 6 × 1.5-h biweekly participatory sessions; based on social action theoryIncreased PA 3 months; NSD 6 monthsI more visits than C More C dropouts, no comparison dropouts to completers
C: One didactic class and two mailingsVolunteer study population
77n = 53; F/U 16 months from BL; 55 yearsI-1: 16 weekly sessions of behavioral modification: calorie logs, group PA, monetary incentives I-2: 16 weekly didactic sessions: nutrition and PA C: Four monthly didactic sessionsImproved eating and PA all groups at 4 months, NSD between groups;regression toward BL at 16 m but remained significantI more visits than C Volunteer study population
78,97n = 79; F/U immediate; 68 yearsI-1: 10 × 60-min diet education sessions over 4 months; adapted for elderly I-2: I-1 + peer support: group sessions; modeling, reinforcement C: Usual carePeer support levels correlated with weight loss, glycemic control, P < 0.05Randomized by site No BL comparisons or attrition information I more visits than C Community recruitment; volunteer study population
83n = 596; F/U immediate, 6 months; 51 yearsI: More nutrition content, follow food pyramid C: Usual education, given meal plan Both I and C: 5 × 2-h weekly group sessionsNSD physical function between choice/no choice groups or between I and CRandomized into choice/no choice of program, then I and C Attrition 28%, dropouts younger, more male No mention blinding assessor Physician-referred patients or volunteers
93n = 70; F/U 6 months from BL; 58 yearsI: 22 h over 11 weeks, interactive teaching based on cognitive motivational theory C: Didactic teaching, 14 h over 3 days Focus for both I and C: diet and foot careIncreased dietary CHO but NSD between groups Decreased % fat for both groups at 1 month, I > C, P = 0.004I more contact than C
95n = 20; 12 months from BL; 61 yearsI: Group education (diet, PA, BS control) q3 months × 4 C: Usual careNSD quality of lifeI more contact than C Unclear if study population represents target population
106n = 53; F/U 16 weeks from BL; 55 yearsI-1: Nutrition education: 16 weekly sessions; exchange system diet, goal-setting I-2: Nutrition education: four monthly sessions; exchange system diet, goal-setting C: Behavior modification: 16 weekly visits; calorie-counting diet, goal-settingDecreased caloric intake and % calories from fat in I and C, P < 0.001; NSD between groupsI-2 more visits than C Volunteer study population I-1 and I-2 combined in analysis, as NSD between groups
107n = 152; F/U 10, 14 weeks from BL; >50 yearsI: 10 × 2-h sessions over 14 weeks, culturally sensitive video; nutrition focus C: No interventionDecreased intake kcal/d C males, P = 0.04 Decreased cholesterol intake C females, P = 0.013No BL comparisons I more visits than C Attrition 30.2% No information on dropouts No information on blinding assessor Volunteer study population
4. Skills teaching interventions
90n = 50; F/U 1 year from BL; 54 yearsI: Focused on relationship weight loss and BS control; monetary incentivesReduction in medications both groups, NSD between groupsVolunteer study population
C: Weight loss program Both groups: 12 weekly meetings, then monthly × 6, F/U in 3 months; behavioral weight control programDecreased caloric intake C, P < 0.004 Decreased depression both groups, NSD between groups
5. Coping skills interventions
86n = 32; F/U 2 years; 68 yearsI-1: Six weekly sessions + 18 monthly support group sessions: coping, discussion, educationIncreased quality of life Decreased stress I-1 vs. C at 6 months P < 0.05C is nonrandomized comparison group More visits for I-1 > I-2 > C
I-2: Six weekly sessions only; wait list for support group C: Visual careNo information on attrition Unclear if study population represents target population
Type of DM unclear
  • 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; 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.