Table 4 —

Effect of self-management training on glycemic control

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 sessions as needed C: Started same education 4 weeks laterDecreased HbA1c at 4 weeks I vs. C, P < 0.05I more visits than C No BL statistics Attrition 29%, dropouts not equal  to completers at BL
Low participation rate, but NSD participants and nonparticipants
34n = 345; F/U immediate; 58 yearsI: Nine multimedia education classes over 1.5 years C: Usual careNSD HbA1c or FBSNo mention blinding assessor Low participation rate; nonparticipants older, more male
35n = 77; F/U 6–18 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/UDecreased FBS for C and I at 1 month, NSD between groups NSD from BL at 6 monthsNo BL comparison statistics; no attrition information; No blinding for diet history Low recruitment rate and no information on nonparticipants
47n = 51; F/U 12 months from BL; 53 yearsI: Three weekly didactic, small group sessions q4 months + q2 months visit with doctorDecreased HbA1c and FBS in I vs. C, P < 0.05 Exact values not givenI more visits than C No information on participation rates
C: Visit with doctor q2 months
57n = 31; F/U 1 week, HbA1c F/U 2 months; 65 yearsI: Four weekly TC after hospital discharge: identify deficits and teach C: No TC or other contactNSD HbA1c between groupsI more contacts than C Unclear if assessor blinded 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 monthsDecreased FBS 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
26n = 80; F/U 6 months from BL; 53 yearsI: Group sessions: didactic and discussions; no details duration or frequency; F/U q3 months C: Care at general medical clinic q3 monthsDecreased FBS in I vs. C at 6 months (9.7 vs. 6.4 mmol/l), P < 0.01Attrition 25%, no comparison dropouts to completers
27,28n = 532; F/U 12–14 months; 57 yearsI: Average 2.4 sessions × 1.5-h over 2 months + home visit, TC F/U, contracting, skill excercises, goal-setting; over 26 months C: Usual careDecreased HbA1c in I (0.43%), P < 0.05, increased in C (0.35%) Decreased FBS I vs. C, P < 0.05I more visits than C Attrition 51%, differences dropouts and completers No blinding assessor Low participation rate
29n = 238; F/U 3, 6, 12 months post BL; 56 yearsI-1: 13 individual sessions in 12 months I-2: Three-day group interactive course + F/U 3 and 9 months + 2 individual sessions I-3: Six or more individual sessions based on cognitive behavioral theory, TC F/U over 12 months C: 2 × 1-h group educationDecreased HbA1c for all groups at all F/U intervals NSD between groupsBL differences: I-2 better educated; I-1 had longer duration DM I more visits than C Dropouts longer duration DM than completers Unclear if study population represents target population
30n = 46; F/U immediate, 6 months; 66 yearsI: 8 × 2-h small group sessions over 3 months; problem- and participant-focusedNSD HbA1c at 6 monthsMore C excluded due to poor control I more visits than C No mention blinding assessor
C: One-day didactic teachingNonparticipants older and heavier
32n = 174; F/U 4–6 months; 57 yearsI-1: Computer knowledge assessment program (KAP) + interactive computer teaching (60 min) I-2: KAP (20–40 min) + feedback I-3: KAP only C: No interventionDecreased HbA1c I-2 (−1.3%, P < 0.05) and I-3 (−0.08%, P < 0.05)Randomization by year and month birth (no details given) I more contact than C NIDDM results reported here (49% of total study population “IDDM”)
40,60n = 558; F/U 6 months; 45 yearsI-1: Collaborative education by HCW, 3 h/week × 4 weeks I-2: Same education led by fellow patient C: No intervention I based on Fishbein and Ajzen Health Belief ModelNSD HbA1c at 6 monthsHospitals randomized I more visits than C Uncertain blinding assessor
48n = 82; F/U 6 months post BL; 56 yearsI-1: 11 × 2-h weekly didactic course + 1 individual session I-2: 11-week course + three individual sessions: barriers and support C: Usual careFBS and HbA1c decreased for I-1 and I-2 at 3 and 6 months, P < 0.05No BL statistics comparing groups I more visits than C Attrition 40%, no comparison dropouts to completers Volunteer study population
50n = 40; F/U 3 months; 57 yearsI: CAI, 4 × 1-h session: didactic, some feedback and testing C: Didactic group teaching; 4 × 3-hDecreased GHb I (relative change 11%), P < 0.05, increased C (14%), P < 0.05, between group difference, P = 0.001No BL group comparison statistics Low participation rate, no information on nonparticipants or dropouts
54n = 1.07; F/U 1, 4 months; 60 yearsI: 2 × 2-h group didactic + practice + feedback + usual careNSD BS at 4 monthsRandomized by hospital number No blinding assessor
C: Usual care: individual education  based on perceived patient need Both in IP settingNo information on participation rates
55n = 41; F/U 2 months; 60 yearsI-1: Three-day program + group session with pharmacistNSD % change in BS between I and CNo BL comparisons I more contact than C
I-2: Three-day program + individual session with pharmacist; TC F/U23% had unusable data for SMBG
C: Standard center 3-day education program
59n = 60; F/U 3 months from BL; 55 yearsI: Three-day group education, with F/U of 4 TC and 1 home visit; reinforce knowledge and skillsNSD HbA1c between groupsI more contact than C Unclear if study population represents target population
C: Three-day group education
87n = 247; F/U 12 months from BL; 54 yearsI: 12 weekly sessions over 3 months; Spanish videos, followed by 14 group support sessions in 9 months, by lay HCW C: Wait listed for the interventionDecreased GHb 1.7% in I, increased 0.3% in C Decreased FBS 18.9 mg/dl in I, increased 3.9 in CNo BL comparison I more contact than C No information on attrition No mention blinding assessor No statistics
96n = 156; F/U ? immediate; 58 yearsI-1: Patient selects behavior for improvement I-2: Behavioral strategies to increase compliance I-3: Behavioral strategies + instruction on behavioral analysis C: Routine care with consistent F/U by RN: I-1,2,3 based on social cognitive theory I over 13 monthsNSD GHb I and CNo information on attrition Volunteer study population Number of patient contacts unclear F/U interval unclear
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 GHb or BS at 32 weeksAttrition 24%, no comparison dropouts to completers No mention blinding assessor Unclear if study population represents target population
99n = 56; F/U 6 months; 64 yearsI: Monthly ×6 group sessions: behavior modification (contracts, feedback), general knowledge C: Usual careDecreased GHb immediate F/U I and C (P <0.05), NSD between groups; NSD at 6 months Decreased FBS I at immediate F/U, NSD between groupsI more contact than C Attrition 32%, no comparison dropouts to completers Participation rate 37%, no comparison participants to nonparticipants
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 HbA1c I-1 (−2.4%, P < 0.025) and I-2 (−3.3%, P < 0.001) Decreased HbA1c correlated with decreased CHO variation, P < 0.02No mention blinding assessor Study population selected by researchers; low participation rate Type of diabetes unclear (“insulin dependent”)
36n = 87; F/U 12 months from BL; 56 yearsI: Five group sessions over 6 months, focus on weight lossDecreased HbA1c I at 6 months, P < 0.001; NSD I vs. C at 1 year
C: Individual education on weight loss by dietitian; 3 or more visits in 12 months
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 of teachingNSD HbA1 or fructosamine at immediate F/U Decreased HbA1 at 18 months (10.8 to 9.6, P < 0.001)I more contact than C Attrition appears to be 76% at 12 months F/U; no comparison dropouts to completers No mention blinding assessor Crossover design No information on patient recruitment
43n = 201; F/U 6 months; 53 yearsI: Culturally appropriate flashcards: diet, SMBG; delivered by lay HCWDecreased HbA1c in I (−0.34%, P > 0.05) I more contact than C
C: Usual careIntensity of intervention unclear
49n = 41, F/U 6 months; 61 yearsI: Psychologist-led group sessions on PA and dietDecreased HbA1c for I and C, NSD between groupsDropouts (22%) had higher mean BS; equal number dropouts I and C
C: Didactic lectures on diet and DM Both groups 10 × 1-h sessions over 6 monthsDecreased mean BS at 6 months for I, between group difference, P < 0.05Low participation rate, no information on nonparticipants
66n = 148; F/U 6 months from BL; 55 yearsI: Advice to decrease fat to <30% total calorie intake C: Advice to decrease CHO to <40% total calorie intake Both I and C received individual counseling by dietitian; three home visitsNSD HbA1c between groups NSD fasting plasma glucose between groups
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 monthsNSD HbA1c at 12 monthsUnclear if food record reviewers were 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 months Both groups 3 visits/3 months basic education before randomizationDecreased FBS for I > C at 15 months, P = 0.02; NSD 27 months NSD HbA1c 15 and 27 monthsI more visits than C No mention blinding assessor No information on nonparticipants I more contact than C
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 dietitianNSD GHb
C: Review session × 3
71n = 60; F/U 12 weeks from BL; 55 yearsI: Individualized advice on low glycemic index foodsDecreased FBS I and C, significant only for I, P < 0.05No mention blinding assessor Unclear how much intervention time
C: Standard, individualized diet adviceDecreased fructosamine I vs. C, P < 0.05
72n = 78; F/U 2 months; 42–75 yearsI-1: 5 × 2-h weekly education: calories, fat, fiberNSD GHbNo BL information I more visits than C
I-2: I-1 + goal setting, problem-solving, feedbackMore attrition in C, no comparison dropouts to completers
C: Wait listed for IUnclear 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 INSD HbA1 immediate or 6 monthsIncomplete BL statistics I more visits than C No mention blinding assessor Volunteer study population Crossover design Type of DM uncertain (“IDDM”)
74n = 102; F/U 3, 6 months from BL; 67 yearsI: 10 weekly sessions: problem-solving, increased self efficacy, diet and PA focus C: Wait listed for IDecreased HbA1c in I and C at 3 months (0.5%), NSD between groups, return to BL at 6 monthsRandomization blocked by medication I more visits than C Volunteer study population
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 diet and exercise sessions, based on social action theoryDecreased HbA1c at 3 months (−1.5%) and 6 months (−1.1%), P < 0.01I more visits than C More C dropouts, no comparison dropouts to completers Volunteer study population
C: One didactic class and two mailings
77n = 53; F/U 16 weeks, 16 months from BL; 55 yearsI-1: 16 weekly sessions: behavioral modification, calorie logs, group PA, monetary incentivesDecreased FBS and HbA1c all groups at 16 weeks, P < 0.01, NSD between groupsI more visits than C Volunteer study population
I-2: 16 weekly didactic sessions nutrition and PANSD FBS and HbA1c at 16 months
C: Four monthly didactic sessions
78,97n = 79; F/U immediate; 68 yearsI-1: 10 × 60-min diet education sessions over 4 months; adapted for elderlyDecreased HbA1c at 8 weeks, for I-2, P < 0.05, not maintained at 16 weeksRandomized by site No BL comparisons or attrition information
I-2: I-1 + peer support: group sessions, modeling, reinforcement C: Usual careI more visits than C Community recruitment; volunteer study population
79,100,101n = 76; F/U 3, 6, 18 months from BL; 54 yearsI-1: Diet focus; goal-setting, modify environment I-2: PA focus with participation I-3: Diet + PA C: Didactic teaching All groups: 10 × 2-h weekly sessions: I based on behavior and cognitive modification strategiesDecreased BS I-1 vs. C at 6 months, P < 0.037; NSD HbA1c Decreased HbA1c 1–3 vs. C at 18 months (difference 1.8%, P < 0.05)Randomized by group meeting attended Volunteer study population
80n = 40; F/U 2, 5 months from BL; 59 yearsI: 3 × 1.5-h individual learning activity packages with diet information, goals, activities C: 3 × 1.5-h didactic lecturesDecreased HbA1c in C (4.5%) at 5 months, P < 0.05; NSD I groupAttrition 23%, no comparison dropouts to completers Volunteer study population from DM education program
81,102n = 247; F/U 6 months from BL; 57 yearsI: Three or more individual visits with dietitian, over 6 weeks, following practice guidelines C-1: One visit producing nutrition care plan C-2: Nonrandomized comparison group; no interventionDecreased FBS and HbA1c I at 6 months, P < 0.001; decreased C-1, P < 0.01; NSD between I and C-1Nonrandomized C-2 C less time with dietitian Attrition 28% for lab studies, unclear  if dropouts equal completers at BL Volunteer study population or physician-referred
83n = 596; F/U immediate, 6 months; 51 yearsI: More nutrition content, follow food pyramidDecreased HbA1c in C (0.9%, P = 0.035)Randomized into choice/no choice of program, then I and C
C: Usual education, given meal plan Both I and C: 5 × 2-h weekly group sessionsPatient choice had no effectAttrition 28%, dropouts younger, more male No mention blinding assessor Physician-referred patients or volunteers
84n = 163; F/U immediate, 6 months; 64 yearsI: Six monthly sessions on diet C: Usual care; wait listedDecreased postprandial BS at 6 months in I vs. C, P = 0.009No BL statistics I more visits than C
Attrition 47%, but dropouts equal completers at BL
No information on patient recruitment Type of DM unclear
88n = 80; F/U 12 months from BL; 56 yearsI: Six individual sessions on diet, by nurseDecreased FBS all groups, P < 0.01, NSD between groupsNo BL statistics
C: Physician gave handout at initial visit on weight loss Both groups 6 visits/12 monthsDecreased HbA1c C females and I males, P < 0.001, NSD between groups
90n = 50; F/U 1 year from B/L; 54 yearsI: Focused on relationship weight loss and BS control; monetary incentives C: Weight loss programNSD HbA1c at 1 year for I or CVolunteer study population
Both groups: 12 weekly meetings, then monthly ×6, F/U in 3 months; behavioral weight control program
91n = 120; F/U 7, 11 months from BL; 54 yearsI-1: Six monthly small-group meetings, diet and PA information; audio-visual materials culturally sensitiveNSD HbA1c between or within groups at 7 or 11 monthsI more visits than C Attrition 32% at 11 months, NSD dropouts to completers
I-2: 1-h didactic + five monthly discussions on BS control
C: 1-h didactic only
92n = 40; F/U immediate, 6 weeks; 54 yearsI: Behavioral group: 6 × 1.5-h weekly meetings; cues for eating, daily recordDecreased BS immediate F/U for I, P < 0.05, NSD 6 weeks NSD between groups for BSI more visits than C Unclear how patients selected
C: Individual diet counseling, total 1.25 h
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 careNSD FBS either group Decreased fructosamine both groups at 1 month, P < 0.0001, return to BL at 6 monthsI more contact than C
94n = 23; F/U 6 months from BL; 33–70 yearsI: Self-management skills (stimulus control, monitoring, reinforcement); 5 diet classes/day for 5 days C: Conventional teaching 1 h/day × 5; Both groups: 5-days IP admission; F/U q2 weeks for 2 months, then 3 and 6 monthsFBS decreased both groups, NSD between groups at 6 monthsRandomized by week of admission No BL statistics No mention blinding assessor Patients selected by physicians
95n = 120; 12 months from BL; 61 yearsI: Group education (diet, PA, BS control) q3 months × 4 C: Usual careNSD HbA1c, FBSI more contact than C Unclear if study population represents target population
4. Skills teaching interventions
61n = 20; F/U 1 year from end 16-week I; 53 yearsI: Information on how to use BS measures by adjusting diet and PA C: Self-monitoring of BS; no feedback Both groups: 13 sessions over 16 weeks, then 9 in 6 months; didactic and participatory; focus on weight controlDecreased HbA1c both I and C at immediate F/U, P < 0.0001, NSD between groups, NSD from BL at 1 yearNo mention blinding assessor Volunteer study population
63n = 50; F/U 6 months; adultI: Additional participatory teaching on foot care during OP educationDecreased HbA1c I, P = 0.002 and C, P = 0.051Randomized by week entering program; no BL comparisons
C: Usual education, with routine, didactic foot educationNo values or between group statisticsAttrition 35% I, 44% C, no comparison dropouts to completers
Both groups: 5 days OP DM educationNo mention blinding assessor No demographic data; type of DM unclear
5. Coping skills interventions
85n = 64; F/U 6 weeks; 50 yearsI: 6 × 2-h weekly group sessions: patient empowerment, goal-setting, problem-solving, stress management C: Wait listedDecreased HbA1c I > C P = 0.05, I decreased 0.73%No BL comparisons; 18 patients not randomly assigned I more contact than C Volunteer study population 64% DM2 HbA1c measured immediately after program for C, 6 weeks after for I
86n = 32; F/U 2 years from BL; 68 yearsI-1: Six weekly sessions + 18 monthly support group sessions: coping, discussion, educationDecreased HbA1c I-1 and I-2 vs. C at 2 years, P < 0.05; NSD between I-1 and I-2C is nonrandomized comparison  group More visits for I-1 > I-2 > C
I-2: Six-weekly sessions only; wait list for support group C: Usual careNo information on attrition Unclear if study population represents target population
Type of DM unclear
105n = 55; F/U 3, 6, 12, 18 months from BL; 53 yearsI-1: Behavior modification: focus on self-control procedures; records of diet and exerciseNSD HbA1c
I-2: Cognitive modification: focus on cognitions; self-statements; goal-setting
I-3: Cognitive-behavior modification: combined I-1 and I-2
C: Relaxation training to cope with stress All groups got nine weekly sessions of 1.5 h
  • 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; DM, 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.