Table 7 —

Conclusions of a review of randomized, controlled trials of the effectiveness of self-management training in type 2 diabetes

A. Effectiveness of interventions
1. In the short term (<6 months), knowledge levels, SMBG skills, and self-reported dietary habits improve.
2. In the short term, improvements in glycemic control, knowledge, and diet are more readily demonstrated than improvements in weight and physical activity levels.
3. Improved glycemic control does not correspond to measured changes in knowledge or SMBG skills.
4. Weight loss can be demonstrated with repetitive interventions or with short-term follow-up (<6 months).
5. Physical activity levels are variably affected by interventions.
6. Effects on lipids and blood pressure are variable and more likely to be positive with interactive or individualized, repetitive interventions.
7. Studies with short-term follow-up are more likely to demonstrate positive effects on glycemic control and behavioral outcomes than studies with longer follow-up intervals.
8. Interventions with regular reinforcement are more effective than one-time or short-term education.
9. Interventions that involve patient participation and collaboration seem to produce somewhat more favorable effects on glycemic control, weight loss, and lipid profiles than didactic ones.
10. Group education is more effective for lifestyle interventions and seems to be equally effective for interventions focusing on knowledge and SMBG.
11. The focus of the current literature has been on knowledge and glycemic control outcomes; there is little literature measuring quality of life and long-term clinical outcomes.
B. Methodological issues
1. Descriptive information is frequently lacking, including type of diabetes and the representativeness of study populations to target populations.
2. Threats to internal validity (selection, performance, attrition, and detection bias) are common.
3. Generalizability of study results is often limited by enrollee or researcher selection into study populations or by lack of information on the representativeness of the study population.
C. Potential future research topics
1. Systematic review of the effectiveness of self-management training interventions in patients with type 2 diabetes using study designs other than randomized, controlled trials.
2. Effectiveness studies to define optimal long-term and maintenance interventions with respect to content, frequency, and method of delivery.
3. Studies to further delineate the impact of self-management training on intermediate outcomes, such as self-efficacy, problem-solving, and coping skills, and to better define the relationship between these outcomes and behavior change, glycemic control, and long-term outcomes.
4. Studies examining the feasibility, effectiveness, and cost-effectiveness of population-based self-management training, as compared with individual patient-centered training.
5. Quantitative review of self-management training effectiveness to further examine the heterogeneity of the literature, and the relationships between population characteristics, study design and quality, intervention characteristics, and outcomes.
6. Effectiveness studies focusing on long-term cardiovascular, quality of life, and economic outcomes.