Behavioral programs for diabetes mellitus
Project Summary Title and Description
- Behavioral programs for diabetes mellitus
- A systematic review focusing on the effectiveness of behavioral programs for type 1 diabetes (T1DM), and identifying factors contributing to program effectiveness for type 2 diabetes (T2DM).
- Authors of Report
- Methodology description
- Two reviewers independently assessed studies for fit with predetermined selection criteria and assessed risk of bias. We included prospective controlled studies and randomized controlled trials (RCTs) for T1DM and RCTs for T2DM, evaluating behavioral programs compared with usual care, active controls (e.g., didactic education), or other behavioral programs. One reviewer extracted data, with verification by a second reviewer. For T1DM, we conducted pairwise meta-analysis to assess program effectiveness; subgroup analyses to examine patient variables (e.g., age, race/ethnicity, glycemic control); and meta-regressions to assess potential moderators of effectiveness, such as program components (i.e., diabetes self-management education [DSME], DSME plus support, lifestyle), intensity, delivery format, and personnel. For T2DM, we conducted network meta-analysis (incorporating direct and indirect comparisons) to assess potential moderation of program effectiveness, and subgroup analyses to assess the impact of patient variables. Strength of the body of evidence (SOE) for key outcomes in T1DM was assessed to determine our confidence in the results.
- The full report entitled "Behavioral Programs for Diabetes Mellitus" (Evidence Report 221) can be viewed at http://www.effectivehealthcare.ahrq.gov/. The Supplementary File includes figures (forest plots) containing all Outcome Results data that was used for the traditional meta-analyses in this review. Except for the Supplementary File, all data for this project was entered into SRDR prospectively.
- Funding Source
- Agency for Healthcare Research and Quality
- 1. For patients with type 1 diabetes, are behavioral programs implemented in a community health setting effective compared with usual or standard care, or active comparators in, a) improving behavioral, clinical, and health outcomes, b) improving diabetes-related health care utilization, and c) achieving program acceptability as measured by participant attrition rates?
- 2. For patients with T1DM, do behavioral programs implemented in the community health setting differ in effectiveness for behavioral, clinical, and health outcomes, their effect on diabetes-related health care utilization, or program acceptability, for subgroups of patients based on: age (i.e., children and adolescents [≤18 years] and their families, young adults [19-30 years], adults [31-64 years], older adults (≥65 years]); race or ethnicity; socioeconomic status (e.g., family income, education level, literacy); time since diagnosis (i.e., ≤1 year vs. >1 year); and, level of glycemic control (e.g., HbA1c <7 vs. ≥7 percent])?
- 3. For patients with T1DM, does the effectiveness of behavioral programs differ based on the: a) components; b) intensity (i.e., program duration, frequency/periodicity of interactions); b) delivery personnel (e.g., dietitian, exercise specialist, physician, nurse practitioner, certified diabetes educator, lay health worker); c) method of communication (e.g., individual vs. group, face-to-face, interactive behavior change technology, social media); d) degree of tailoring based on needs assessment (e.g., educational/behavioral deficits, age or other demographics, readiness to change); or e) level and nature of community engagement?
- 4. For patients with T1DM, what are the associated harms (i.e., activity-related injury) of behavioral programs implemented in a community health setting compared with usual care, standard care, or active comparators?
- 5. Among behavioral programs targeted at adults with T2DM implemented in a community health setting, what factors contribute to: a) their effectiveness for behavioral, clinical, and health outcomes; b) their effect on diabetes-related health care utilization; and c) program acceptability as measured by participant attrition rates? Factors include program components, program intensity, delivery personnel, methods of delivery and communication, degree of tailoring, and community engagement.
- 6. Do the factors that contribute to program effectiveness for patients with T2DM vary across the following subpopulations: age (i.e., young adults [19-30 years], adults [31-64 years], older adults [≥65 years]); race or ethnicity; socioeconomic status (e.g., family income, education level, literacy); time since diagnosis (i.e., ≤1 year vs. >1 year); and, level of glycemic control (i.e., HbA1c <7 vs. ≥7 percent)?
Associated Extraction Forms
Associated Studies (each link opens a new tab)
Downloadable Data Content
- XLSX Project Data