Glycemic trajectory after face-to-face diabetes self-management education: a dose-response meta-analysis

This dose-response meta-analysis (DRMA) examined HbA1c trajectories after face-to-face Diabetes Self-Management Education (DSME) and whether program duration, frequency, or intensity modified outcomes over time. MEDLINE, Embase, and CINAHL were searched to February 15, 2025. Eligible studies included adults with type 2 diabetes receiving face-to-face DSME and reporting pre- and post-intervention HbA1c levels. Intervention-arm data from randomized, quasi-experimental, and observational studies were analyzed as single-group pre-post cohorts. Risk of bias was assessed using the NIH Before-After Studies tool, and REMR-based meta-regression with restricted cubic splines modeled HbA1c change over time. Of 161 eligible studies, 103 were included after excluding outliers and studies outside the predefined baseline HbA1c range. DSME was associated with a rapid HbA1c reduction of approximately 1.3% within 30 weeks, followed by gradual attenuation toward baseline by 52 weeks. Sensitivity analyses across restricted baseline HbA1c ranges showed similar trajectories, suggesting regression to the mean did not fully explain the findings. Data beyond one year were sparse. Conventional face-to-face DSME programs produce substantial short-term glycemic improvement, but benefits diminish over time and this was unrelated to initial program intensity.