Diabetes self‐management programmes in older adults: a systematic review and meta‐analysis

Sherifali, Diana; Bai, Johnny-Wei; Kenny, Meghan; Warren, Rachel; Ali, Muhammad Usman

doi:10.1111/dme.12780

Cited by 83 publications

(78 citation statements)

References 22 publications

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“…Twenty-two of the 79 research papers were reviews. Of those, 15 were systematic reviews, 79,80,82,84,89,90,93,101,[125][126][127]131,132,137,143 one was a realist review 134 and six were non-systematic reviews. 25,37,45,66,73,105 The rest of the research papers (n = 57) related to primary research.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…In a meta-analysis of SM programmes in older people living with diabetes, Sherifali et al 126 concluded that the strategies most effective at reducing HbA 1c levels were those that involved tailored interventions or psychological support. Tailored interventions consisted of patients receiving advice and support that met their particular needs and goals for diabetes SM and the psychological support emphasised coping strategies for depression and distress.…”

Section: Tailored and Flexiblementioning

confidence: 99%

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Managing diabetes in people with dementia: a realist review

Bunn

Goodman

Jones

et al. 2017

Health Technol Assess

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BackgroundDementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes.ObjectivesTo identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research.DesignRealist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders.ParticipantsTwenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference.Data sourcesThe following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing – UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA).ResultsWe included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context–mechanism–outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia.LimitationsThere is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven.ConclusionsThis review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes.Study registrationThis study is registered as PROSPERO CRD42015020625.FundingThe NIHR HTA programme.

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Section: Description Of Studiesmentioning

confidence: 99%

Section: Tailored and Flexiblementioning

confidence: 99%

Managing diabetes in people with dementia: a realist review

Bunn

Goodman

Jones

et al. 2017

Health Technol Assess

View full text Add to dashboard Cite

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“…However, the carrying out of educational interventions shows that many complications can be prevented through strict control of glucose levels in the blood (1)(2)(3)(4) . Thus, it is argued that education for care in diabetes mellitus is relevant, because the user with this condition needs to develop self-care skills, such as following a healthy diet, engaging in physical activities, monitoring blood glucose, and taking medication have a good capacity for problem solving and adopt healthy behaviors to prevent complications (2,5) .…”

Section: Introductionmentioning

confidence: 99%

“…Thus, it is argued that education for care in diabetes mellitus is relevant, because the user with this condition needs to develop self-care skills, such as following a healthy diet, engaging in physical activities, monitoring blood glucose, and taking medication have a good capacity for problem solving and adopt healthy behaviors to prevent complications (2,5) . In addition, the literature indicates the time of participation in educational programs as an important factor, and it presents studies that prove the effectiveness of interventions of both long and short duration (4,6) . Regarding the forms of measurement of the effect of an intervention, a meta-analysis conducted on eight scientific databases, and which included original studies of randomized clinical trials, revealed that the duration of the intervention influenced its effect.…”

Section: Introductionmentioning

confidence: 99%

“…In other words, the amount of contact time spent with users with diabetes in order to develop their autonomy is distinct from that which aims to make them responsible for their health (7)(8)(9) . Based on what has been presented, it is argued that the present study is justified based on the fact that there is little research in the national and international literature that assesses the impact of contact time on the results of educational programs for diabetes mellitus (4) . This gap was also identified by a meta-analysis study, which stressed that more studies on the frequency and duration of intervention could provide useful information for the effectiveness of educational interventions (8)(9) .…”

Section: Introductionmentioning

confidence: 99%

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Relationship between the users' contact time in educational programs on diabetes mellitus and self-care skills and knowledge

Maia

Reis

Torres

2016

Rev. esc. enferm. USP

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Objective: Check the relationship between the users' contact time in educational programs and self-care and knowledge variables in diabetes mellitus. Method: A longitudinal study with a quantitative approach with the participation, in the initial phase, of 263 users linked to Basic Health Units in Belo Horizonte, Brazil during the years 2012 and 2013. The data were collected with respect to the total contact time of the users' participation in the educational program as regards knowledge and self-care in acquired diabetes mellitus. The data were analyzed using the Student t-test for comparison of means, considering a 0.05 significance level. Results: The final sample included 151 users. The analysis showed that the improvement in self-care scores was statistically higher during an educational intervention of eight hours or more (p-value <0.05). In relation to the scores for knowledge, there was a statistically significant improvement at the end of the educational program. It was not possible to identify a value for the contact time from which there was an increase in mean scores for the ability of knowledge. Conclusion: To improve the effectiveness of the promotion of skills related to knowledge and self-care in diabetes mellitus, it is necessary to consider the contact time as a relevant factor of the educational program.

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Association Between Perceived Barriers to Diabetes Self-management and Diabetic Retinopathy in Asian Patients With Type 2 Diabetes

et al. 2017

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IMPORTANCE A patient's perceived barriers to diabetes self-management (DSM) may affect his or her risk of diabetic retinopathy (DR); however, few studies have examined this association.OBJECTIVE To examine the association between perceived barriers to DSM and the severity spectrum of DR in Asian patients with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional clinic-based study, the Singapore Diabetes Management Project, was conducted from December 28, 2010, to March 20, 2013, at the Singapore National Eye Centre, a tertiary eye care institute. After excluding patients with type 1 diabetes and ungradable fundus images, 361 participants were included in the analyses. Statistical analysis was conducted from July 20 to September 8, 2017.EXPOSURE The degree of perceived barriers to DSM was assessed using a 23-item questionnaire comprising items about knowledge of DSM, access to care, and confidence in health care professionals. Rasch analysis was used to optimize the scale's psychometric properties, with lower scores indicating a higher degree of self-perceived barriers.MAIN OUTCOMES AND MEASURES Diabetic retinopathy was graded from 2-field retinal images into categories of no DR (Early Treatment Diabetic Retinopathy Study levels 10-15; n = 154), mild to moderate DR (levels 20-43; n = 112), and severe DR (levels Ն53 and/or presence of clinically significant macular edema; n = 95) using the modified Airlie House classification system of DR. Multinomial logistic regression models were used to assess the association between perceived barriers and severity of DR in the worse-affected eye. RESULTS Among the 361 participants (105 women and 256 men; mean [SD] age, 57 [8] years), a greater magnitude of perceived barriers to DSM was independently associated with higher odds of having any DR (odds ratio, 1.32; 95% CI, 1.06-1.66), mild to moderate DR (odds ratio, 1.30; 95% CI, 1.01-1.68), and severe DR (odds ratio, 1.36; 95% CI, 1.03-1.79). This association was independent of diabetes control (hemoglobin A 1c , blood pressure, and lipid levels), presenting visual acuity, and socioeconomic indicators. CONCLUSIONS AND RELEVANCEThese results suggest that greater perceived barriers to DSM are independently associated with severity of DR. Although longitudinal data are needed, these findings suggest that evidence-based interventions to reduce patient-, practitioner-, and system-related barriers to diabetes care may help reduce the risk of DR.

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Diabetes self‐management programmes in older adults: a systematic review and meta‐analysis

Abstract: Diabetes self-management programmes for older adults demonstrate a small reduction in HbA(1c), lipids and blood pressure. These findings may be of greater clinical relevance when offered in conjunction with other therapies.

Cited by 83 publications

References 22 publications

Managing diabetes in people with dementia: a realist review

Managing diabetes in people with dementia: a realist review

Relationship between the users' contact time in educational programs on diabetes mellitus and self-care skills and knowledge

Association Between Perceived Barriers to Diabetes Self-management and Diabetic Retinopathy in Asian Patients With Type 2 Diabetes

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