Approaches to Diabetes Self-Management Education in Europe: An Extensive Literature Review

Type 1 (T1DM) and type 2 diabetes mellitus (T2DM) are long-term chronic conditions that require complex, ongoing management, much of which takes place outside the clinical setting and falls on the individuals living with the disease. This study aimed to provide insights into the landscape of diabetes education practices across Europe through a comprehensive literature-based analysis of Diabetes Self-Management Education (DSME) programs in seven European countries: France, Germany, Italy, Spain, Sweden, the Netherlands, and the United Kingdom. These countries were selected to reflect different healthcare system models, funding structures, and diabetes prevalence rates. The study also aimed to examine how the impact of these programs has been evaluated.

We conducted an extensive, narrative literature review to map and compare DSME programs across the selected European countries. The literature review was performed using search strings on four bibliographic databases, complemented by manual searches of relevant websites and hand-searches of references of eligible papers. Data were extracted based on a predefined Excel template. We assessed how program impact has been evaluated within seven key domains: health outcomes, patient-reported outcomes, behavior/coping, beliefs, knowledge, cost/resource consumption, and cost-effectiveness. For the domains of patient-reported outcomes, behavior/coping, beliefs, and knowledge, we further mapped the instruments used and their frequency of use across studies.

A total of 151 articles pertaining to 126 DSME programs were included in the review. We found considerable differences both within and across countries in terms of program format (eg, individual vs group sessions, intensity, frequency, and duration), delivery methods, and the professionals involved in delivering education. Health outcomes were the most frequently used outcomes to assess DSME impact (84% of the studies). Patient-reported outcomes and behavior/coping outcomes were the next most commonly assessed domains (57% and 54%, respectively), although the instruments used varied substantially. Assessment of costs/resource use and the conduct of economic evaluations were rare.

T1DM and T2DM remain major public health issues worldwide. DSME plays a crucial role in supporting effective disease management. Establishing consensus on the key features of high-quality DSME programs, as well as standardizing approaches to impact evaluation, are essential steps toward ensuring equitable access to care across Europe.