Effectiveness of self‐management interventions in young adults with type 1 and 2 diabetes: a systematic review and meta‐analysis

Abstract

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

Research Implications for Future Telemedicine Studies and Innovations in Diabetes and Hypertension—A Mixed Methods Study

“…After updating the search and again applying eligibility criteria of the recently published umbrella review [ 14 ], 10 relevant new records [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ] were identified. Consecutively, 35 records, namely systematic reviews ( n = 9), meta-analyses ( n = 5), systematic reviews and meta-analyses ( n = 18) or other designs like meta-regressions ( n = 2) or network-meta-analyses ( n = 1), were included for further analysis.…”

“…This refers to frequency, duration and delivery mode (e.g., via HCP, SMS, SNS) of feedback [ 34 , 36 , 41 , 49 ], as well as components of the intervention in general [ 37 ] and their combinations(s) [ 29 , 36 , 39 , 47 ] and contextual distinctions [ 29 , 37 ]. Some authors call for investigating strategies of tailoring [ 36 ], behavior change techniques the interventions should be based on [ 33 ], and the effectiveness assessment of specific elements like gamification and social media [ 41 , 50 ]. The second subcategory points to a need for a more holistic [ 29 ], standardized [ 37 ] and theory-grounded [ 31 , 36 , 50 ] assessment of interventions’ features and functionalities.…”

“…The third topic refers to an improved understanding of patients' characteristics being associated with the overall effectiveness [33,51], i.e., their technology acceptance [28] as well as with initiating and sustaining the use of the intervention [30,39]. Some authors call for different [46] or more diverse patient subgroups [49], e.g., by performing studies in a larger variety of countries [29].…”

“…Basic Theories and/or frameworks [29,31,36,37,50] "Future research should clearly identify and report the explanatory frameworks, mechanisms and theories for the social network interventions being tested [50]." Need for in-depth considerations of patients' characteristics and more diverse study populations -Improved understanding of patient characteristics [28,33,39,51] "Future studies also need to examine whether certain patient characteristics are more likely to result in initiating and sustaining the use of diabetes apps [39]." [39] "Ethical considerations for the risk of data privacy also need to be carefully addressed [39]."…”

Effective SLOPE: EffectS of Lifestyle interventions in Older PEople with obesity: a systematic review and network meta-analysis protocol

“…Finally, as recommended in obesity guidelines 83 we will include all self-management interventions that intend to support behaviour changes (such as motivational interviewing, social support, cognitive-therapeutic intervention). 84 This is owed to the fact that many (older) people with chronic diseases (such as diabetes or obesity) have difficulties to control intended behavioural changes (such as improving eating behaviour, increasing physical activity and decreasing sedentary time). 85 In addition, self-efficacy, self-regulation skills were found important mediators for successful weight change.…”