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Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis
Annals of Internal Medicine
|September 29, 2015
Summary
Behavioral programs for type 2 diabetes are most effective with sufficient contact hours and support. Programs benefit individuals with poorer glycemic control more significantly.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Behavioral Medicine
Background:
- Behavioral interventions show potential for improving outcomes in type 2 diabetes mellitus.
- Significant diversity exists in behavioral interventions, leading to uncertainty in optimizing effectiveness.
- Research is needed to identify factors that moderate the efficacy of these programs.
Purpose of the Study:
- To identify factors moderating the effectiveness of behavioral programs for adults diagnosed with type 2 diabetes.
Main Methods:
- A systematic review and Bayesian network meta-analysis of 132 randomized controlled trials.
- Searches conducted across 6 databases, conference proceedings, and reference lists from 1993 to 2015.
- Data extraction and risk of bias assessment performed by independent reviewers.
Main Results:
- Lifestyle and diabetes self-management education and support programs (≥ 11 contact hours) significantly improved glycemic control (≥ 0.4% HbA1c reduction).
- Programs with fewer contact hours or lacking added support showed minimal benefit.
- In-person delivery and programs targeting individuals with higher baseline HbA1c, younger adults, and minority groups demonstrated greater efficacy.
Conclusions:
- Diabetes self-management education programs with limited contact hours (≤ 10) offer little benefit.
- Behavioral interventions appear more beneficial for individuals with suboptimal or poor glycemic control.
- All included trials exhibited medium to high risk of bias, and subgroup analyses were exploratory.
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