Table 6 —

Effect of self-management training on economic and health care utilization outcomes

Referencen, F/U interval, and mean ageInterventionsOutcomesReordered comments
1. Didactic, knowledge, and information interventions
34n = 345; F/U immediate; 58 yearsI: Nine multimedia education classes over 1.5 years C: Usual careNSD sick days, admissions, emergency room or OP visitsNo mention blinding assessor Low participation rate; nonparticipants older, more male
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 monthsMore sick leave events/year for C vs. I, P < 0.05 NSD duration sick leave eventsNo mention blinding assessor Low participation rates, no information on nonparticipants Clofibric acid arm double-blinded
2. Collaborative, knowledge, and information interventions
40,60n = 558; F/U 6 months; 45 yearsI-1: Collaborative education by HCW, 3 h/week × 4 weeks I-2: Same education by fellow patients C: No intervention I based on Fishbein and Ajzen Health Belief ModelNSD quality of life NSD sick days, use of health services, daily insulin dosage, number injections Cost per intervention patient (including indirect costs): $100Hospitals randomized I more visits than C Uncertain blinding assessor
46n = 471; F/U 6, 12 months from BL; 52 yearsI: Home visits, teaching based on needs assessment, maximum 12 visits C: Usual careNSD emergency room and physician visits, hospitalizations, length of stay, DM-related sick days at 1 yearAttrition 20%; no comparison dropouts to completers 70% of eligible participated
54n = 107; F/U 1, 4 months; 60 yearsI: 2 × 2-h group didactic + practice + feedback + usual careDecreased emergency room visits for I vs. C, P = 0.005Randomized by hospital number No blinding assessor
C: Usual care: individual education based on perceived patient needNo information on participation rates
Both in IP setting
3. Lifestyle interventions
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 monthsDirect costs of intervention $137 per patient NSD quality of lifeUnclear if food record reviewers were blinded Low participation rate; participants differ from nonparticipants
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 strategiesIncreased quality of life for I-3 at 18 months, P < 0.05Randomized by group meeting attended Volunteer study population
81,102n = 203; 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 interventionCost per % change GHb lower for C; no statistics Cost effectiveness ratio $56.26 per % change in HbA1cNonrandomized C-2 C less time with dietitian Attrition 28% for lab studies, unclear if lab dropouts equal completers at BL Volunteer study population or physician-referred
  • 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.