Interactive self-management programs help people with poorly controlled diabetes decrease blood sugar levels

Cheng L, Sit JWH, Choi K-C et al. Effectiveness of interactive self-management interventions in individuals with poorly controlled type 2 diabetes: A meta-analysis of randomized controlled trials Worldviews Evid Based Nurs. 2016;14:65-73.

Review question

Do interactive self-management programs help people with poorly controlled diabetes decrease their blood sugar levels? Do the programs also increase people’s knowledge about how to manage their condition, confidence in their ability to do so and quality of life?

Background

Many people with diabetes have difficulty controlling their blood sugar levels. People with persistently high blood sugar are at greater risk for developing complications, including heart, kidney and eye diseases. Research has shown that compared to traditional instructional programs, interactive programs are more effective at helping people with type 2 diabetes better manage their condition. This review aims to see if interactive programs can specifically benefit people with poorly controlled type 2 diabetes.

How the review was done

This is a review of 16 randomized-controlled trials conducted from 1997 to 2015, including a total of 3 545 participants. All the studies were combined in a meta-analysis. Most of the studies were considered to be of moderate quality.

• All participants were adults with poorly controlled type 2 diabetes (HbA1c > 7.5%)
• Study participants were involved in interactive self-management programs, which provided support and advice on topics such as diet, physical activity, medications and blood sugar monitoring.
• Program facilitators met with participants via telephone calls, group sessions and/or individual meetings. In most of the programs, these interactive sessions took place weekly. Programs ranged from six to 18 months long.
• Researchers measured changes in participants’ blood sugar levels (HbA1c), as well as changes in healthy habits (e.g. exercise, taking medications), nutrition knowledge, quality of life, confidence in managing their condition and feelings about their diabetes.
• Results were compared to control groups who participated in fewer or no interactive self-management sessions.

What the researchers found

People who participated in the interactive self-management programs maintained lower HbA1c levels for up to one year. A smaller number of studies showed that self-management programs also improved people’s nutrition knowledge, confidence in managing their condition and feelings about their diabetes. Programs that were based in scientific theories, used structured learning curriculums, involved phone- or web-based communication and/or provided feedback on participants’ performance were most effective in lowering blood sugar. More research is needed to see how the self-management programs can be used to sustain better blood sugar control in the long-term.

Conclusion

Interactive self-management programs appear to help people with poorly controlled diabetes decrease their blood sugar levels, at least in the short term. The programs may also help increase people’s nutrition knowledge and improve their feelings about diabetes and its management.