Liberalized diet in patients with type 1 diabetes

Mühlhauser, Ingrid; Bott, U.; Overmann, H.; Wagener, W.; Bender, R.; Jörgens, Viktor; Berger, Michael

doi:10.1111/j.1365-2796.1995.tb00890.x

Cited by 42 publications

(31 citation statements)

References 23 publications

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“…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. In practice, a total of 11 were identified [5,28,30,32,34,38,39,[43][44][45][46], and seven [28,32,34,35,38,39,46] were included in at least one of the reviews. In six reviews the main controlled trials of our reference programmes [28, 30-32, 38, 44] were included in data synthesis [10,11,16,18,19,25].…”

Section: Resultsmentioning

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%

“…Liberalisation of the diet may be important to motivate patients to carry out an intensified insulin therapy regimen in the long term [5]. Though indispensable, knowledge by itself may not improve outcomes.…”

mentioning

confidence: 99%

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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“…The primary goals of treatment are to maintain blood glucose levels and quality of life as close as possible to those of non-diabetic people [6]. Intensified insulin therapy improves metabolic control and reduces the incidence of complications [7,8] but, to fully benefit from it, patients need knowledge and skills that enable them to make informed choices to facilitate appropriate behavioural changes [1,9,10]. Such benefits can only be achieved if patients are offered structured and comprehensive education integrated in diabetes care.…”

Section: Introductionmentioning

confidence: 99%

A 3-year prospective randomized controlled clinical trial of group care in type 1 diabetes

Trento

Passera

Borgo

et al. 2005

Nutrition, Metabolism and Cardiovascular Diseases

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Summary Background and aims: We showed that continuing education can be embedded into routine diabetes care by seeing patients in small groups rather than individually. Group care was cost-effective in improving quality of life, knowledge of diabetes, health behaviours and clinical outcomes in people with type 2 diabetes. The aim of this study was to verify if group care can also be applied to type 1 diabetes. Methods and results: Randomized, controlled clinical trial comparing 31 patients managed by group care with 31 managed by traditional one-to-one care. A syllabus was built and later remodulated with the patients in a series of focus-group meetings. The primary end-point was changes in quality of life. Secondary endpoints were: knowledge of diabetes, health behaviours, HbA1c and circulating lipids. Differential costs to the Italian National Health System and to the patients were also calculated.After 3 years, quality of life improved among patients on group care, along with knowledge and health behaviours (p ! 0.001, all). Knowledge added its effects to those of group care by independently influencing behaviours (p Z 0.004) while quality of life changed independently of either (p ! 0.001). Among controls, quality of life worsened (p ! 0.001) whereas knowledge and behaviours remained unchanged. HDL cholesterol increased among patients on group care (p Z 0.027) and total cholesterol decreased in the controls (p ! 0.05). HbA1c

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“…Berger argued otherwise. Without denying the importance of healthy living as a protection against cardiovascular disease, he recognised that the rationale for dietary restriction was the inadequacy of conventional insulin regimens [7]. 'Type 1 diabetes', he said, 'is an insulin deficiency disease.'…”

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confidence: 99%

Type 1 diabetes: treatment without tears?

Amiel

2005

Diabetologia

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Liberalized diet in patients with type 1 diabetes

Cited by 42 publications

References 23 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

A 3-year prospective randomized controlled clinical trial of group care in type 1 diabetes

Type 1 diabetes: treatment without tears?

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