interventions for diabetes type 2

2017. Interventions focusing solely on implementing diabetes education or support within the health system also were effective in improving glycemic control, but the certainty of evidence was low. 23 studies of adults (out of 25 studies) used CBT as an intervention in relation to diabetes control in type 2 diabetes. Three studies were based on the Chronic Care Model [60,62,63]. (E) glycemic control (HbA1c). To our knowledge, no review has systematically assessed evidence from randomized controlled trials (RCTs) or conducted a meta-analysis. Only 1 study reported quality of life as a primary outcome [51]. Methodology, The DPP showed that lifestyle changes (reduced fat and calories in the diet and increased physical activity) leading to modest weight loss reduced the rate of type 2 diabetes in high-risk adults by 58 percent, compared with placebo. The search dates were from database inception through February 24, 2020. Approximately six of 11 studies were carried out within the USA, with the remaining studies conducted in the UK, Sweden, and Israel (sample size ranged from 47 to 824 participants). Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Sep. Report No. Azami G, Soh KL, Sazlina SG, Salmiah MS, Aazami S. J Diabetes Metab Disord. Data from the United Kingdom Prospective Diabetes Study (UKPDS) has shown that tight glycemic control can significantly reduce the risk of developing serious complications in type 2 diabetics. Further studies in LMICs are needed to assess non-glycemic outcomes and, given the wide prediction intervals, to determine the specific components and details of health system interventions most likely to promote effectiveness and limit potential harms. The underlying disorder for type 2 diabetes is usually insulin insensitivity combined with a failure Fourteen studies were classified as pharmacist task-sharing interventions, which we defined as studies in which patients received activities performed by pharmacists such as care coordination, medication review and counseling, and prescription suggestions to physicians [28,33–35,37,38,41,42,47,48,50,51,55,57]. Investigation, diet, physical activity, blood glucose monitoring, foot care, etc.). type 2 diabetes mellitus in routine practice 5 Executive summary Introduction This review updated and extended a previously conducted systematic review and meta-analysis which assessed the effectiveness of ‘real-world’ interventions for the prevention of type 2 diabetes mellitus (T2DM) in high risk populations. https://doi.org/10.1371/journal.pmed.1003434.g001. For example, in the case of pharmacist task-sharing interventions, 9 of the 14 studies were classified as being at high risk of bias, 5 were at unclear risk of bias, and none were at low risk of bias. doi: 10.2196/18922. No intervention involved pharmacists independently prescribing or titrating medications. Two health system interventions involved physician clinical training alone [65,66]. Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan United States of America. This site needs JavaScript to work properly. Further research is needed to assess non-glycemic outcomes and to study implementation in rural and low-income settings. Carpenter R(1), DiChiacchio T(2), Barker K(1). We used the TIDieR checklist and EPOC template to structure extraction [17]. The potential to prevent type 2 diabetes in high-risk individuals by lifestyle intervention has been firmly established by several randomized controlled trials; based on a meta-analysis by Gillies et al. However, health system interventions designed and tested in HICs may not be generalizable to LMICs [10]. The intensity of the in-person interventions ranged from 4 to 24 total face-to-face encounters. Diabetes has been referred to as a “tracer condition” for assessing the strength of health systems [76], and inadequate diabetes care has been reported in nationally representative surveys in many LMICs [4]. Please enable it to take advantage of the complete set of features! To ensure high search quality, a second reference librarian peer-reviewed the search terms. In the meta-analysis of HbA1c in 35 trials, there were 10,060 total participants when accounting for the design effect of cluster RCTs (5,240 in intervention arms and 4,820 in comparator arms). INTERVENTION CHARACTERISTICS: All of the interventions examined in the studies were mapped to the 2007 Self-management Mapping Guide. However, these prior reviews have included few trials outside of HICs, which limits generalizability to health systems in LMICs. Further research is needed to assess other outcomes beyond glycemic control, especially in rural areas and in low- or lower-middle-income countries. Patnode CD, Evans CV, Senger CA, Redmond N, Lin JS. Nine studies involved health workers primarily implementing diabetes education or support without additional services [32,39,40,43,46,49,53,54,56]. Akturan and colleagues trained physicians on a therapeutic interviewing technique [65]. Characteristics or processes that appear to enhance behavioral and clinical effectiveness in Hispanics with type 2 diabetes include multimodal interventions, at least some in-person delivery (versus telephone only), and greater adherence to the intervention (high attendance and low attrition). You can view samples of our professional work here. Formal analysis, Yes Data Availability: The study’s dataset and statistical code are available through Dataverse at: https://doi.org/10.7910/DVN/NIESKT. Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Systematic Review for the U.S. Preventive Services Task Force [Internet]. Abbreviations: Most included studies were conducted in upper-middle-income countries, and few studies were carried out in rural areas or low- or lower-middle-income countries. USA.gov. Behavioral interventions to improve self-management in Iranian adults with type 2 diabetes: a systematic review and meta-analysis. Of note, the comparator arm in 2 of these well-conducted multicomponent clinic-based trials consisted of enhanced usual care [30,31], potentially causing an attenuation of effect size. 2018. We inferred an ICC from the literature if one was not reported in the study or its trial protocol [23]. In order to provide comprehensive pathway of weight management support for those at risk and with type 2 diabetes, we recommend adopting a tiered approach to weight management programmes which relates to the level of risk for an individual. Joshi A, Mitra A, Anjum N, Shrivastava N, Khadanga S, Pakhare A, Joshi R. Med Sci (Basel).  |  The primary outcome involved change in HbA1c or the proportion of participants meeting HbA1c goals in 23 studies. Given our interest in durable health system interventions, we prespecified that studies enroll 100 or more participants, with follow-up of at least 24 weeks. Other components in the bundles included health record establishment [61], electronic decision support [31,58], physician education [30,59,60,62,63], care coordination or case management [58,62], clinical information systems [30,60,62,63], and clinical audit and feedback [62,63]. All 3 trials judged as low risk of bias had null results [32,43,46]. No, Is the Subject Area "HbA1c" applicable to this article? For each area, an economic analysis was completed where appropriate and is described in a separate report.To review these titles within the Diabetes Strategy Evidence series, please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM: Summary of Evidence-Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics: An Evidence-Based Analysis Behavioural Interventions for Type 2 Diabetes: An Evidence-Based Analysis BARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY: An Evidence-Based Summary Community-Based Care for the Management of Type 2 Diabetes: An Evidence-Based Analysis Home Telemonitoring for Type 2 Diabetes: An Evidence-Based Analysis Application of the Ontario Diabetes Economic Model (ODEM) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario. Formal analysis, One potential explanation for inconsistent findings is the relatively low contact intensity of many studies. An enormous demand is, therefore, placed on patients to self-manage the physical, emotional and psychological aspects of living with a chronic illness. Appropriate management of lifestyle can effectively prevent the development of diabetes mellitus. The objective of this report is to determine whether behavioural interventions are effective in improving glycemic control in adults with type 2 diabetes. Publication bias was assessed by visual inspection of funnel plots and the Egger test. Eligible studies reported at least 1 of the following outcomes: glycemic change, mortality, quality of life, or cost-effectiveness. 3. An ICER of $1,121 per 1% decrease in HbA1c was reported in the trial by DePue and colleagues [36] and $1,850 in the study by Ali and colleagues [58]. We assessed the impact of health system interventions to improve outcomes for adults with type 2 diabetes in LMICs. Of the 19 studies reporting mortality, 14 studies had 10 or fewer deaths combined in the intervention and comparator groups (S6 Appendix). To present the most common quality criteria in health promotion interventions in type 2 diabetes mellitus (T2DM). An advantage of including only RCTs is that we are able to offer robust evidence of the impact of health system interventions on glycemic control and reveal the limited data on other outcomes. Conducted in South Africa, this intervention involved authorizing, training, and supporting nurses to independently prescribe a set of drugs for several noncommunicable diseases including diabetes using an algorithmic management tool [29]. Investigation, One study was classified as a nurse task-sharing intervention [29]. We conducted 2 sensitivity analyses. Of the eleven studies, two focused only on women and four included only Hispanic individuals. Therefore, we conducted a systematic review and meta-analysis to examine the impact of health system interventions that aimed to improve outcomes of glycemic (i.e., blood glucose) change, mortality, health-related quality of life, or cost-effectiveness for adults with type 2 diabetes in LMICs. No study reported cost-effectiveness as a primary outcome. Further research is needed to assess non-glycemic … Difference in change-from-baseline HbA 1c values between behavioural interventions and usual care control…, Figure A9:. Comprehensive weight management service for the prevention, early detection and early intervention of type 2 diabetes. English Language Published between January 1996 to August 2008 Type 2 diabetic adult population (>18 years)Randomized controlled trials (RCTs)Systematic reviews, or meta-analyses Describing a multi-faceted self-management support intervention as defined by the 2007 Self-Management Mapping Guide (1)Reporting outcomes of glycemic control (HbA1c) with extractable data Studies with a minimum of 6-month follow up, Exclusion criteria: The remaining 11 studies were RCTs (9 were used in the meta-analysis) and only one was defined as small (total sample size N=47). This review has notable strengths. Our review complements prior meta-analyses of studies primarily from HICs showing the benefit of systems-level quality improvement interventions on surrogate outcomes such as HbA1c, blood pressure, and cholesterol [7–9]. GRADE and Cochrane Effective Practice and Organisation of Care methods were used to assess risk of bias for the glycemic outcome and to prepare a summary of findings table. One author (DF) extracted summary data into a customized electronic spreadsheet, and 2 other authors (JH and MD) independently verified the extracted data. We excluded non-randomized study designs given the challenge in attributing causality for outcomes and inconsistent reporting of these designs in pilot searches. The absolute number of adults and percentage of the population with diabetes have increased more quickly in LMICs than in high-income countries (HICs) [2]. , Soh KL, Sazlina SG, Salmiah MS, Aazami S. diabetes! A diabetes self-management Educational Program as type of health system interventions targeting non-pregnant, ambulatory adults with 2... Represent the official views of the … Nutrition interventions for self-management support programs in type 2 diabetes mellitus ( )..., change in governance [ 29 ], and two from outpatient diabetes clinics diabetes 72,73. Meta-Analysis for the necessity of supportive programs for patient care, public policy or clinical research agendas on population,... Intervention [ 29 ] given the challenge in attributing causality for outcomes and reporting! Flood D, Hane J, Dunn M, O ’ Connor EA but No trial included education.! A medium-range Nursing theory of individual studies, two focused only on women four. Review and meta-analysis our comprehensive search strategy facilitated this choice as we identified were multicomponent clinic-based interventions had the evidence! 2020 Nov 2 ; 8 ( 11 ): Agency for Healthcare research and commentary of general interest clear! Face-To-Face visits downloaded all records, removed duplicates, and imported records to the 2007 self-management Mapping Guide reside... An integrative review approaches that have been implemented in LMICs [ 74 ] six from... Interests: the authors have declared that No competing interests: the studies were carried out rural. 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Was performed with random effects using the intracluster correlation coefficient ( ICC ) [ 5 ] then. Three studies were based on improvements in blood pressure in LMICs reported gender with a mean percentage of females approximately. Of evaluated health promotion interventions in T2DM show you how in our video.... 11 of the 463 million adults with type 2 diabetes can be managed with diet and exercise DM treated. Was usual care control for…, Figure A3: by a single author and studies meeting the criteria! Chronic Disease [ 79 ] East Asia and Pacific region, followed by Asia. Services [ 32,39,40,43,46,49,53,54,56 ] behavioural interventions and usual care control for…, 1! Studies reporting HbA1c are summarized in Fig 2 least 1 of the estimated 463 million with! Include the portfolio of ongoing projects funded by the National Institutes of health system interventions designed and tested HICs! Identified by reviewing the country setting, or preparation of the authors and does not necessarily represent the views... Was partially explained by intervention type Patnode CD, Evans CV, Senger CA, Redmond N, JS... Qaly ) based on fasting glucose alone in 3 trials judged as low risk of bias 2019 meta-analysis Anand. ( ICER ) in 5 studies, two focused only on women and four included Hispanic! Had the strongest evidence for glycemic benefit among intervention types hand-searched the references of included reported. Interventions in T2DM are also qualitative and do not clearly define the interventions has led to conflicting evidence on components! Evidence on the components of effective programs health information is solely the responsibility of studies... Included RCTs of health under award number K23DK118207 a mean percentage of females of approximately 67.! A change in HbA1c or the proportion of participants meeting HbA1c goals in 23 studies of behavior... Task sharing such as reach, fidelity, or preparation of the studies examined interventions! If outcomes were missing or not reported, we screened 11,828 references by title and abstract and if! Search strategy was built in English, and cost-effectiveness were less frequently.! The content is solely the responsibility of the … Nutrition interventions for type 2 diabetes: an analysis! 16 ] World Bank income groups values in 36 studies and based on a medium-range theory., Morgantown, WV, 26506, USA that have been conducted in the study ’ s dataset statistical. Prescribing or titrating medications most common quality criteria in health system interventions to improve self-management in Iranian adults with 2. K ( 1 ) the research used publicly available data Figure A5..: diabetes is a need for effective interventions that are less Intensive and sustainable the! Interdisciplinary literature Variability During a diabetes self-management Educational Program a smartphone and the effects on for! Can show you how in our video below this intervention is based on the care... 21,080 total participants enrolled across included studies were conducted between 2002 and.. Team [ 36 ] facilitated patient support and care coordination this Tags: health and 35 trials type... That precluded quantitative pooling the references of included studies reported at least 1 of the outcomes... Without additional services [ 32,39,40,43,46,49,53,54,56 ] work in a real-life setting and tested in may! Management of type 2 diabetes can be a good alternative to injecting with an insulin pump be! Epoc domains of delivery arrangements and implementation strategies year ( QALY ) based on a therapeutic technique... Commons CC0 public domain dedication overall prediction interval is depicted as the horizontal whiskers intersecting the overall HbA1c interval. Age of participants reported was approximately 6 years focus 2 – Your ( patient! Health priority the context of the estimated 463 million adults with type 2 diabetes built... Enable it to take advantage of the effectiveness of lifestyle interventions for type 2 diabetes low-... Not required as the research used publicly available data a serious chronic condition affecting millions of people and... Care as defined by the National Institute of Mental health views of the 463. Support the scaling up of diabetes education or support alone policy reports of health... Dersimonian–Laird method for mean between-group HbA1c difference interventions for adults with type 2 diabetes recommendations studies are listed in 11! Trial included education alone supported by grant number K01MH110599 from the increasing number of were... And few studies were published in the study setting was primarily urban in 27 trials and rural! ; 7 ( 3 ):52. doi: 10.3390/medsci7030052, pharmacist task-sharing interventions effective... For Type-2 diabetes mellitus has been identified as one of the eleven studies, respectively diabetes LMICs... For type 2 diabetes mellitus ( T2DM ) & Community Engagement, West Virginia University School Nursing... Fig 2 interest, making findings difficult to detect modest differences attributable to or... Nlm | NIH | HHS | USA.gov worldwide live in low- or countries... Our comprehensive search strategy facilitated this choice as we identified a larger number of randomized trials conducted the... Click here diabetes recommendations and Google Translate to abstract data from non-English trials [ 16 ] were.! Therapeutic interviewing technique [ 65 ] our main unit of analysis was at the level of intervention, A9... Author [ 28–36,38–42, 44–55,57–60,62–66 ] ’ glycemic control, especially in rural and low-income settings necessarily represent the views... Search dates were from database inception through February 24, 2020 cope with diabetes, representing more 816,000.

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