Diabetes patient education: a meta-analysis and meta-regression

Ellis, Shelly; Speroff, Theodore; Dittus, Robert S.; Brown, Anne; Pichert, James W.; Elasy, Tom A.

doi:10.1016/s0738-3991(03)00016-8

Cited by 411 publications

(329 citation statements)

References 40 publications

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“…In six reviews only RCTs were considered [9,10,13,15,18,26,27] (see ESM Table 12). Following the selection criteria of the reviews, 16 publications [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] referring to our three reference programmes should have been identified.…”

Section: Resultsmentioning

confidence: 99%

“…It was assessed: (1) whether the selection criteria and search strategies used in the included systematic reviews were appropriate for detection of the 'increasing evidence' of the three reference programmes (ESM Tables 1, 2, 3); (2) which publications related to our three reference programmes had been identified; (3) whether theoretical background literature (theoretical/preclinical phase) had been considered; (4) which active components had been identified and included (ESM Tables 4, 5, 6); (5) whether classification of interventions matched the type of intervention; and (6) whether all relevant patient outcomes had been included (ESM Tables 7,8,9).…”

Section: Methodsmentioning

confidence: 99%

“…However, if studies are clinically or methodologically heterogeneous, data-pooling may be meaningless and genuine differences in effects may be obscured [8]. Complex interventions are heterogeneous in their goals, methods and target populations [9][10][11][12][13][14]. Thus, using meta-analysis to evaluate complex interventions may disregard the complexity of the efficacy measures used in the original studies.…”

mentioning

confidence: 99%

“…Thus, using meta-analysis to evaluate complex interventions may disregard the complexity of the efficacy measures used in the original studies. For example, HbA 1c is used as a single outcome variable without considering individual treatment goals or effects on hypoglycaemia, body weight or quality of life [9,15,16]. An increase in HbA 1c from 6.5 to 7% might be considered a deterioration, but would clearly be a desirable outcome if it halved the rate of hypoglycaemia.…”

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confidence: 99%

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Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Lenz¹,

Steckelberg²,

Richter

et al. 2007

Diabetologia

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Common methodologies used in systematic reviews do not allow adequate appraisal of complex interventions. The aim of the present study was to describe and critically appraise current methods of systematic reviews on complex interventions, using diabetes and hypertension patient education as examples. PubMed, the Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Library and Health Technology Assessment databases were searched. Systematic reviews focusing on diabetes or hypertension patient education were included. Authors were contacted. Two investigators independently evaluated the reviews. The available evidence of three patient education programmes of diabetes and hypertension self-management implemented in Germany was used as a reference. We included 14 reviews; 12 reviews mentioned that the included education programmes were multidimensional. Reviews on comparable topics identified different publications of the same programme. Identical programmes were classified differently within and between reviews.Education programmes were dissected to analyse effects of single components. Different components of identical programmes were used. Interdependencies between components were not explored. Six reviews performed metaanalysis across programmes with heterogeneous educational or organisational approaches. The complexity of efficacy measures was disregarded: e.g. HbA 1c was used as an isolated outcome variable without considering treatment goals, effects on hypoglycaemia, body weight or quality of life. Our results indicate that methods of current systematic reviews are not fully equipped to appraise patient education and self-management programmes. Since these are complex and heterogeneous interventions, consideration of aggregated evidence is necessary.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Lenz¹,

Steckelberg²,

Richter

et al. 2007

Diabetologia

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“…This suggests that exercise is a major missing or underemphasised component in type 2 diabetes self-management. A previous meta-analysis of diabetes patient education reported that interventions including exercise resulted in larger improvements in metabolic control than interventions not including exercise [25]. No previous meta-analysis has compared exercise-only interventions with interventions including multiple diabetes self-management behaviours.…”

Section: Discussionmentioning

confidence: 99%

Metabolic effects of interventions to increase exercise in adults with type 2 diabetes

et al. 2007

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Aims/hypothesis The aim of this meta-analysis was to integrate the results of primary research testing the effect of diabetes self-management interventions that included recommendations to increase exercise on metabolic outcomes among adults with type 2 diabetes. Materials and methods Extensive literature searching strategies were used to identify published and unpublished intervention studies that measured glycated haemoglobin outcomes. Primary study results were coded. Fixed-and random-effects meta-analytic procedures included moderator analyses.Results Data were synthesised across 10,455 subjects from 103 research reports. The overall mean weighted effect size for two-group comparisons was 0.29 (higher mean for treatment than control). This effect size is consistent with a difference in HbA 1c means of 0.45% (e.g. 7.38% for treatment subjects vs 7.83% for control subjects). For single-group studies, the overall mean weighted effect size was 0.32-0.34. Control group subjects experienced no improvement in metabolic control during participation in the studies. Interventions that targeted multiple health behaviours resulted in smaller effect size estimates (0.22) than interventions that focused only on exercise behaviours (0.45). Funded studies reported greater improvements in metabolic controls. Studies with a greater proportion of female subjects reported lower effect sizes. Baseline HbA 1c and BMI were unrelated to metabolic outcomes. Conclusions/interpretation These findings suggest that self-management interventions that include exercise recommendations improve metabolic control, despite considerable heterogeneity in the magnitude of the intervention effect. Interventions that emphasise exercise may be especially effective in improving metabolic control. Primary research testing interventions in randomised trials to confirm causal relationships would be constructive.Keywords Diabetes mellitus, type 2 . Exercise . Haemoglobin A, glycosylated . HbA 1c . Meta-analysis Abbreviations CLES common language effect size ES effect size GhB glycated haemoglobin Diabetologia (2007) 50:913-921

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Effects of Quality Improvement Strategies for Type 2 Diabetes on Glycemic Control

Shojania

Ranji

McDonald

et al. 2006

JAMA

582

517

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Most QI strategies produced small to modest improvements in glycemic control. Team changes and case management showed more robust improvements, especially for interventions in which case managers could adjust medications without awaiting physician approval. Estimates of the effectiveness of other specific QI strategies may have been limited by difficulty in classifying complex interventions, insufficient numbers of studies, and publication bias.

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Diabetes patient education: a meta-analysis and meta-regression

Cited by 411 publications

References 40 publications

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Metabolic effects of interventions to increase exercise in adults with type 2 diabetes

Effects of Quality Improvement Strategies for Type 2 Diabetes on Glycemic Control

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