Interventions to improve patients’ compliance with therapies aimed at lowering glycated hemoglobin (HbA1c) in type 1 diabetes: systematic review and meta-analyses of randomized controlled clinical trials of psychological, telecare, and educational interventions

Abstract

BackgroundBrazilian records on glycemic control in patients with type 1 diabetes show treatment efficacy. Poor patient adherence to therapeutic proposals influences these results and can be associated with social, psychological, and economic aspects, besides others factors. The aim of this study was to evaluate the efficacy of psychological, telecare, and educational interventions to improve treatment compliance among patients with type 1 diabetes. Compliance was assessed indirectly using reduction of glycated hemoglobin (HbA1c) as the principal outcome measure.MethodsSystematic review and meta-analyses of randomized controlled clinical trials (RCTs) were performed using Medline, Embase, Cochrane and Scopus databases up to April 2015. The following medical subject headings were used: Diabetes Mellitus, Type 1, Patient Compliance or Adherence, Hemoglobin A, glycated, and Randomized Controlled Trial. The principal outcome was change in HbA1c between baseline and follow-up. Where appropriate, trials were combined in meta-analysis using fixed effects models.ResultsFrom 191 articles initially identified, 57 were full text reviewed, and 19 articles met the inclusion criteria providing data from 1782 patients (49.4 % males, age 18 years). The RCTs (2 to 24 months in duration) were divided into four groups according to type of intervention: psychology (seven studies; 818 patients), telecare (six studies; 494 patients); education (five studies; 349 patients), and psychoeducation (one study; 153 patients). All studies reported some type of adherence measurement of the interventions. Decrease in HbA1c was observed after psychology (MD −0.310; 95 % CI, −0.599 to −0.0210, P = 0.035) but not after telecare (MD −0.124 %; 95 % CI, −0.268, 0.020; P = 0.090) or educational (MD −0.001; 95 % CI, −0.202, 0.200; P = 0.990) interventions.ConclusionPsychological approaches to improve adherence to diabetes care treatment modestly reduced HbA1c in patients with type 1 diabetes; telecare and education interventions did not change glycemic control. However, the limited number of studies included as well as their methodological quality should be taken into account.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1207-6) contains supplementary material, which is available to authorized users.

Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer

“…The reviews of de Jongh et al [24] and Viana et al [49] were both weighted 2 stars. The former focused on mobile messaging interventions, including medication reminders, and found no improvement in hemoglobin A 1c (HbA 1c ) compared with usual care in a meta-analysis of 2 RCTs [24].…”

ISPAD Clinical Practice Consensus Guidelines 2018: Psychological care of children and adolescents with type 1 diabetes

“…The results of these studies indicate that family‐based, behavioral procedures such as goal‐setting, problem solving, self‐monitoring, positive reinforcement, behavioral contracts, supportive parental communications, family restructuring, and appropriately shared responsibility for diabetes management have improved regimen adherence and glycemic control . In addition, these interventions have improved the parent‐adolescent relationship, and improved regimen adherence . Studies of behavioral family systems therapy with diabetes‐specific tailoring targeting diabetes‐specific behavioral problems, and training in behavioral contracting techniques have shown improvements in family conflict and regimen adherence as well as improved glycemic control over 18 months .…”

“…Previous systematic reviews of the literature and meta-analysis [174][175][176] indicate that a number of controlled studies have shown the efficacy of psychosocial and behavioral interventions for children and adolescents with diabetes, although this literature is not without some methodological limitations. 4,5,174,[177][178][179][180] Most of these interventions have included the family as an integral part of treatment.…”

Text‐message responsiveness to blood glucose monitoring reminders is associated with HbA1c benefit in teenagers with Type 1 diabetes

“…A variety of educational and behavioural interventions for adolescents with Type 1 diabetes have demonstrated some benefit in terms of glycaemic control; however, the feasibility of incorporating such interventions into clinical practice may be limited by healthcare resources and time, thus limiting scalability [3][4][5][6][7]. Text-messaging interventions have been studied in young people with Type 1 diabetes, and remain a practical and promising strategy [8][9][10].…”