Self-management interventions for type 2 diabetes: a systematic review

Heinrich, E; Schaper, N.C.; Vries, NK de

doi:10.1002/edn.160

Cited by 122 publications

(114 citation statements)

References 36 publications

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“…We identified 14,841 references for screening, of which 17 were included in this meta-review [99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115] ( Figure 10). A total of 322 RCTs were included within these 17 systematic reviews.…”

Section: Systematic Reviews Identifiedmentioning

confidence: 99%

“…100,101,104,106,109,110,112,114,115 The four most commonly reported self-management behaviours were diet, physical activity (PA), self-monitoring of blood glucose (SMBG) and foot care behaviours. Three reviews found strong evidence to support the role of self-management interventions in facilitating dietary change.…”

Section: Secondary Outcomesmentioning

confidence: 99%

“…104,109,110 There was also evidence to suggest that self-management interventions can have beneficial effects on PA levels, although the evidence for this was less strong than for that of dietary change. 104,109,110 Furthermore, evidence suggests self-management interventions can increase the frequency or accuracy of SMBG, 104,109,110,114 with large ESs found in one review, 104 and a corresponding improvement in HbA 1c levels found in another. 110 Foot-care behaviours were reported in four narrative syntheses, all reporting mixed results.…”

Section: Secondary Outcomesmentioning

confidence: 99%

“…110 Foot-care behaviours were reported in four narrative syntheses, all reporting mixed results. 100,104,106,109 Dorrejstein et al 100 focused specifically on foot care and found evidence to suggest that tailored and intensive education can produce beneficial behaviour change, whereas basic foot education was not found to produce any improvements in foot-care behaviour.…”

Section: Secondary Outcomesmentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

344

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Systematic Reviews Identifiedmentioning

confidence: 99%

Section: Secondary Outcomesmentioning

confidence: 99%

Section: Secondary Outcomesmentioning

confidence: 99%

Section: Secondary Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

344

451

View full text Add to dashboard Cite

show abstract

“…Multiple studies confirm the value of diabetes selfmanagement education, demonstrating improved clinical outcomes, quality of life and healthy coping, increased use of primary and preventive services and reductions in diabetes-related costs [3][4][5][6]. Despite the evidence for the effectiveness of diabetes self-management education, participation rates were low for both patient and family groups in DAWN2.…”

mentioning

confidence: 99%