Aim Diabetes in young adulthood has been associated with poor outcomes. Self-management is fundamental to good diabetes care, and self-management interventions have been found to improve outcomes in older adults. We performed a systematic review and meta-analysis to assess the effectiveness of self-management interventions in young adults (aged 15-39 years) with type 1 or type 2 diabetes.Methods We searched five databases and two clinical trial registries from 2003 to February 2019, without language restrictions. We included randomized controlled trials (RCTs) comparing the effectiveness of self-management interventions with usual care or enhanced usual care in young adults. Outcomes of interest included clinical outcomes, psychological health, self-care behaviours, diabetes knowledge and self-efficacy. Pairwise meta-analysis was conducted using a random effects model and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. We followed Cochrane gold standard systematic review methodology and reported this systematic review according to PRISMA guidelines. The protocol was registered with PROSEPRO (CRD42018110868).
ResultsIn total, 13 studies (1002 participants) were included. Meta-analysis showed no difference between selfmanagement interventions and controls in post-intervention HbA 1c levels, BMI, depression, diabetes-related distress, overall self-care, diabetes knowledge and self-efficacy. Quality of evidence ranged from very low to moderate due to study limitations, inconsistency and imprecision.Conclusions Current self-management interventions did not improve outcomes in young adults with diabetes. Our findings, which contrast with those from systematic reviews in older adults, highlight the need for the development of more effective interventions for young adults with diabetes. Diabet. Med. 37, 229-241 (2020) Self-management is a cornerstone of diabetes care. Yet, many have difficulties accomplishing the complex regimen of self-care behaviours, including healthy eating, regular exercise, taking medications as prescribed, managing negative emotions and making regular clinic visits [8]. Additionally, up to 18% of young adults with type 1 diabetes and 30% with type 2 experience moderate to severe depressive symptoms [9], highlighting the need for self-management interventions to facilitate healthy behaviours and achieve optimal diabetes outcomes, while supporting psychological well-being. Self-management interventions form a diverse group, and differ in their method of delivery, mode of communication and intensity [10]. Self-management interventions also incorporate a variety of behavioural change techniques for self-care. The BCT Taxonomy v1
