The effect of family‐based intervention for adults with diabetes on HbA1c and other health‐related outcomes: Systematic review and meta‐analysis

Abstract

Aims and objectives To evaluate the effectiveness of family‐based intervention for adults with diabetes on glycosylated haemoglobin and other health‐related outcomes. Background The impact of family‐based intervention on adults with diabetes has been evaluated in various studies, but there is uncertainty about their effect on health‐related outcomes for adults with diabetes. Design A systematic review and meta‐analysis of randomised controlled trials. Methods A review was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist. Six relevant databases were searched from inception to 5 March 2021. Heterogeneity between studies was quantified by using Higgins’ I2 test. Sensibility and subgroup analyses were used to explore potential heterogeneity. Results The review included 23 studies (3,114 participants). Family‐based intervention had a significant effect on improving glycosylated haemoglobin levels, body mass index, blood pressure, fasting glucose, diabetes self‐care, diabetes self‐efficacy, diabetes distress and positive family support. Non‐significant results were obtained for blood lipid, body weight, depression and negative family support. In particular, subgroup analyses indicated that family‐based intervention in Asian regions was more effective in improving glycosylated haemoglobin levels than in other areas. Conclusion Family‐based intervention may improve diabetes control, diabetes self‐care, psychological well‐being and positive family support in adults with diabetes and is especially effective in Asian regions. Given the limitations in current studies, further studies are recommended to combine family theory with family‐based intervention, and to examine the effectiveness of such intervention for family members. Relevance to clinical practice: This review and meta‐analysis provides evidence that family‐based intervention can improve positive family support, which has a good effect on diabetes control and psychological well‐being in adults with diabetes, and it is especially effective in Asian regions. Findings suggested that unreinforced participation by family members and integrating flexible strategies into family‐based intervention may be equally effective.

Glycemic outcomes of a family-focused intervention for adults with type 2 diabetes: Main, mediated, and subgroup effects from the FAMS 2.0 RCT

“…In a recent trial evaluating another family-focused intervention among adults with type 2 diabetes, Rosland et al [22] also found improved self-efficacy and self-care behaviors, but not HbA1c. In Zhang et al’s 2021 meta-analysis of family-based interventions for adults with diabetes, there was an overall effect on HbA1c, but the effect was much larger when the length of follow-up was 6 months or less [45]. This aligns with our study, where HbA1c trended toward significance at 6 months and then dissipated by 9 months.…”

“…Our findings suggest reducing harmful involvement may be necessary to improve HbA1c; but reducing harmful involvement is challenging. Zhang et al’s [45] meta-analysis found significant improvement in helpful involvement but a non-significant improvement in harmful involvement [45]. Finally, FAMS did not improve medication adherence despite tailored and interactive texts supporting adherence.…”

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023

“…Thus, screening for SDOH (e.g., loss of employment, birth of a child, or other family-based stresses) should also be incorporated into routine care (342). In circumstances where individuals other than the person with diabetes are significantly involved in diabetes management (e.g., caregivers or family members), these issues should be monitored and treated by appropriate professionals (341,343,344).…”

Study protocol for family model diabetes self-management education with Marshallese participants in faith-based organizations

“…This study is grounded in a CBPR approach, which engages Marshallese community members in the research process and builds on the relationship that the study team has cultivated with the Marshallese communities in Arkansas and Oklahoma. This study will add to a growing body of literature on family models of DSMES [ 65 , 66 , 80 ]. This study will provide new and innovative information on the effectiveness of F-DSMES delivered by CHWs in an FBO setting with Marshallese patients with T2DM.…”