Interventions for self-management of type 2 diabetes: An integrative review

Abstract

Background Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage. Since the management of diabetes is mainly accomplished by patients and families, self-management has become the mainstay of diabetes care. However, a significant proportion of patients fail to engage in adequate self-management. A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes? Purpose/Objectives The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with Type II diabetes mellitus. Design An integrative review design, with a comprehensive methodological approach of reviews, allowing inclusion of experimental and non-experimental studies. Procedures A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycArtiCLES, and PsycInfo. The final number of papers used for this review were: motivational interviewing (6), peer support/coaching (10), problem solving therapy (3), technology-based interventions (30), lifestyle modification programs (7), patient education (11), mindfulness (3), and cognitive behavioral therapy (5). Results Studies were examined from seventeen countries including a broad range of cultures and ethnicities. While interventions have shown mixed results in all interventional categories, many studies do support small to modest improvements in physiologic, behavioral, and psychological outcome measures. Considerable heterogeneity of interventions exists. The most commonly reported physiologic measure was HbA1c level. Outcome measures were collected mostly at 6 and 12 months. Duration of most research was limited to one year. Conclusions Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes, from offering suggestions for improving care, to stimulating new questions for research. However, implications for clinical practice remain inconclusive, and limitations in existing research suggest caution in interpreting results of studies.

<p>Effectiveness of Diabetes Self-Management Educational Programs For Type 2 Diabetes Mellitus Patients In Middle East Countries: A Systematic Review</p>

“…This review showed that the absolute effect to improve HbA1c was 1.05%, which was higher than that reported in other systematic review studies (0.50-0.57%), 36,37 while it was lower than that reported by a review for DSME studies among Chinese T2DM patients (1.19%). 38 To confirm the current finding of high effectiveness of DSME program to improve glycemic control inT2DM patients in ME countries, we excluded all studies with poor quality and high risk of bias and the obtained results were also excellent, where 60% of the studies achieved a significant glycemic improvement in IG compared to CG; moreover, their absolute effect to reduce HbA1c is still high (0.99%).…”

“…The current systematic review showed that DSME can significantly improve glycemic control in at least 80% of the studies enrolled in T2DM patients who live in Middle East countries. Many other international review studies showed that HbA1c, 34,35 FBG 17 and NFBG 36 were also significantly improved by DSME in most of the included studies.…”

Lifestyle factors, self-management and patient empowerment in diabetes care

“…Self-management includes meal planning, planned physical activity, blood glucose monitoring, taking diabetes medicines and managing episodes of illness and of low and high blood glucose. 17 The national standards for diabetes self-management education and support define diabetes self-management education as a collaborative and ongoing process intended to facilitate the development of knowledge, skills and abilities that are required for successful self-management of diabetes. 18 To facilitate self-management in chronic diseases, the pattern of patient-provider relation must be more collaborative.…”

Effectiveness of a community program for older adults with type 2 diabetes and multimorbidity: a pragmatic randomized controlled trial

“…The lifestyle modifications targeted by these programs are appropriate for both diabetes prevention and treatment and have demonstrated effectiveness and long-term sustainability. A recent integrative review of 70 studies summarizing the results of testing 8 types of interventions for T2DM across 17 countries reported mixed findings, but noted that many studies supported small to modest improvements in physiologic, behavioural, and psychological outcomes [11]. This review also noted that self-management programs typically involve a range of professionals and non-professionals working together to provide team-based care.…”

“…Reliability has been a key concern with existing studies of community-based programs, since many studies use single-group designs or small samples [15]. The effectiveness of these programs is also uncertain in vulnerable groups such as older adults with multimorbidity because they continue to be underrepresented in diabetes research [11,16,17]. Further, there has been little cost analysis in previous research [11].…”