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 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

Key Questions

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)

A cognitive behavior therapy-based intervention among poorly controlled adult type 1 diabetes patients--a randomized controlled trial.2009
The effect of a diabetes education programme (PRIMAS) for people with type 1 diabetes: results of a randomized trial.2013
Effects of a group-based counselling programme on diabetes-related stress, coping, psychological well-being and metabolic control in adults with type 1 or type 2 diabetes.
Increasing problem solving in adolescents with type 1 diabetes: the choices diabetes program.2002
An office-based intervention to maintain parent-adolescent teamwork in diabetes management. Impact on parent involvement, family conflict, and subsequent glycemic control.1999
Multisystemic therapy compared to telephone support for youth with poorly controlled diabetes: findings from a randomized controlled trial.2012
Effectiveness of groups for adolescents with type 1 diabetes mellitus and their parents.2013
Impact of ambulatory, family-focused teamwork intervention on glycemic control in youth with type 1 diabetes.
Motivational enhancement therapy with and without cognitive behavior therapy to treat type 1 diabetes: a randomized trial.2008
Stress management training for adolescents with diabetes.1993
Multisystemic therapy for adolescents with poorly controlled type I diabetes: Stability of treatment effects in a randomized controlled trial.2007
A randomized controlled trial of Sweet Talk, a text-messaging system to support young people with diabetes.2006
Telehealth behavior therapy for the management of type 1 diabetes in adolescents.2010
Diabetes personal trainer outcomes: short-term and 1-year outcomes of a diabetes personal trainer intervention among youth with type 1 diabetes.2007
Randomized trial of behavioral family systems therapy for diabetes: maintenance of effects on diabetes outcomes in adolescents.
Increasing children's responsibility for diabetes self-care: the In Control study.-- Not Found --
Effects of a behavioral intervention on treatment adherence and stress management in adolescents with IDDM.1997
Assessment of an empowerment education programme. A randomized study in teenagers with diabetes.2007
Motivational/solution-focused intervention improves HbA1c in adolescents with Type 1 diabetes: a pilot study.2003
Evaluation of a weight management intervention program in adolescents with insulin-dependent diabetes mellitus.1993
Lifestyle intervention in people with insulin-dependent diabetes mellitus (IDDM).1997
Clinic-integrated behavioral intervention for families of youth with type 1 diabetes: randomized clinical trial.2012
Approaches to integrating paediatric diabetes care and structured education: experiences from the Families, Adolescents, and Children's Teamwork Study (FACTS).2007
Randomized trial of a diabetes self-management education and family teamwork intervention in adolescents with Type 1 diabetes.2012
Structured, intensive education maximising engagement, motivation and long-term change for children and young people with diabetes: a cluster randomised controlled trial with integral process and economic evaluation - the CASCADE study2014
An empowerment-based educational program improves psychological well-being and health-related quality of life in Type 1 diabetes 2006
Randomized clinical trial of clinic-integrated, low-intensity treatment to prevent deterioration of disease care in adolescents with type 1 diabetes.
Patient education in type 2 diabetes: a randomized controlled 1-year follow-up study.
Effects of lifestyle education program for type 2 diabetes patients in clinics: a cluster randomized controlled trial.2013
A randomized controlled trial of weight reduction and exercise for diabetes management in older African-American subjects.1997
Outcomes of an intervention to reduce uncertainty among African American women with diabetes.2008
Patient empowerment. Results of a randomized controlled trial.1995
Evaluating a problem-based empowerment program for African Americans with diabetes: results of a randomized controlled trial.2005
Managing the space between visits: a randomized trial of disease management for diabetes in a community health center.2010
Soul food light: culturally competent diabetes education.-- Not Found --
Peer advisers compared with specialist health professionals in delivering a training programme on self-management to people with diabetes: a randomized controlled trial.2008
A randomised controlled trial investigating the effect of an intensive lifestyle intervention v. standard care in adults with type 2 diabetes immediately after initiating insulin therapy.
The effects of a web-based intervention on the physical outcomes associated with diabetes among adults age 60 and older: a randomized trial.2007
A CHO/fibre diet reduces and a MUFA diet increases postprandial lipaemia in type 2 diabetes: no supplementary effects of low-volume physical training.2014
Determining the efficacy of a resiliency training approach in adults with type 2 diabetes.
Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative.
Dosage effects of diabetes self-management education for Mexican Americans: the Starr County Border Health Initiative.2005
Integrating education, group support, and case management for diabetic Hispanics.2011
A community-based pilot study of a diabetes pharmacist intervention in Latinos: impact on weight and hemoglobin A1c.2013
Effects of telephone-based peer support in patients with type 2 diabetes mellitus receiving integrated care: a randomized clinical trial.2014
The First Step First Bite Program: guidance to increase physical activity and daily intake of low-glycemic index foods.2009
Effects of a tailored lifestyle self-management intervention in patients with type 2 diabetes.2004
A trial of empowerment-based education in type 2 diabetes--global rather than glycaemic benefits.
Effect of a bicultural community health worker on completion of diabetes education in a Hispanic population.1997
An adaptation of the diabetes prevention program for use with high-risk, minority patients with type 2 diabetes.2007
Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes2005
TeleHealth improves diabetes self-management in an underserved community: diabetes TeleCare.2010
Evaluating the efficacy of an empowerment-based self-management consultant intervention: results of a two-year randomized controlled trial. 2009
Chronic disease self-management in Hong Kong Chinese older adults living in the community2012
Effect of guided self-determination youth intervention integrated into outpatient visits versus treatment as usual on glycemic control and life skills: a randomized clinical trial in adolescents with type 1 diabetes.2014
Behavioral health care for adolescents with poorly controlled diabetes via Skype: does working alliance remain intact?2013
Guided self-determination improves life skills with type 1 diabetes and A1C in randomized controlled trial.2006
Family-based psychoeducation and Care Ambassador intervention to improve glycemic control in youth with type 1 diabetes: a randomized trial.2014
Impact of modified glucose target and exercise interventions on vascular risk factors.2006
Structured patient education: the diabetes X-PERT Programme makes a difference.2006
The effect of a diabetes education, coping skills training, and care intervention on physiological and psychosocial outcomes in black women with type 2 diabetes.
Living well with diabetes: 24-month outcomes from a randomized trial of telephone-delivered weight loss and physical activity intervention to improve glycemic control.
The independent and combined effects of aerobic exercise and dietary fish intake on serum lipids and glycemic control in NIDDM. A randomized controlled study.1997
REDEEM: a pragmatic trial to reduce diabetes distress.
The effects of a commercially available weight loss program among obese patients with type 2 diabetes: a randomized study.2009
A randomized comparison of a commercially available portion-controlled weight-loss intervention with a diabetes self-management education program.2013
Evaluation of a behavior support intervention for patients with poorly controlled diabetes.
Type 2 diabetes patients educated by other patients perform at least as well as patients trained by professionals.2013
Clinical, metabolic and psychological outcomes and treatment costs of a prospective randomized trial based on different educational strategies to improve diabetes care (PRODIACOR).2013
Effects of diet and/or exercise on the adipocytokine and inflammatory cytokine levels of postmenopausal women with type 2 diabetes.2005
Twelve-month outcomes of an Internet-based diabetes self-management support program.2012
Robustness of a computer-assisted diabetes self-management intervention across patient characteristics, healthcare settings, and intervention staff.2006
Effects of a brief computer-assisted diabetes self-management intervention on dietary, biological and quality-of-life outcomes.2006
Long-term effects of self-management education for patients with Type 2 diabetes taking maximal oral hypoglycaemic therapy: a randomized trial in primary care.2004
Improving glycemic control in older adults using a videophone motivational diabetes self-management intervention.2010
The effect of diabetes self-management education with frequent follow-up on the health outcomes of African American men.-- Not Found --
The effect of an education programme (MEDIAS 2 ICT) involving intensive insulin treatment for people with type 2 diabetes.2012
Effect of problem-solving-based diabetes self-management training on diabetes control in a low income patient sample.2011
Self-regulation and weight reduction in patients with type 2 diabetes: a pilot intervention study.2009
A comparison of diabetes education administered through telemedicine versus in person.2003
"Sticking to it—Diabetes Mellitus": A Pilot Study of an Innovative Behavior Change Program for Women with Type 2 Diabetes2002
Improved cardiovascular health following a progressive walking and dietary intervention for type 2 diabetes.
Changes in diabetes self-care behaviors make a difference in glycemic control: the Diabetes Stages of Change (DiSC) study.2003
A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes: impact on physical activity.
Effects of lifestyle modification on metabolic parameters and carotid intima-media thickness in patients with type 2 diabetes mellitus.2006
A community-based, culturally tailored behavioral intervention for Korean Americans with type 2 diabetes.
Effects of self-management training in Type 2 diabetes: a randomized, prospective trial.2007
General practice and social service partnership for better clinical outcomes, patient self efficacy and lifestyle behaviours of diabetic care: randomised control trial of a chronic care model.2011
Spanish diabetes self-management with and without automated telephone reinforcement: two randomized trials.2008
Community-based peer-led diabetes self-management: a randomized trial.2009
Online diabetes self-management program: a randomized study.2010
Promotora diabetes intervention for Mexican Americans.2007
Effects of music therapy and music-assisted relaxation and imagery on health-related outcomes in diabetes education: a feasibility study.
Pounds off with empowerment (POWER): a clinical trial of weight management strategies for black and white adults with diabetes who live in medically underserved rural communities.2004
Comparison of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a randomized controlled trial.2014
The efficacy of diabetes patient education and self-management education in type 2 diabetes2011
The effects of total energy expenditure from all levels of physical activity vs. physical activity energy expenditure from moderate-to-vigorous activity on visceral fat and insulin sensitivity in obese Type 2 diabetic women2010
Efficacy of a self-management education program for people with type 2 diabetes: results of a 12 month trial.2009
Self-monitoring of blood glucose in overweight type 2 diabetic patients.1994
Dance and peer support to improve diabetes outcomes in African American women.2009
Empowered diabetes management: life coaching and pharmacist counseling for employed adults with diabetes.2013
Peer-led diabetes education programs in high-risk Mexican Americans improve glycemic control compared with standard approaches: a Project Dulce promotora randomized trial.2011
The effects of a supplemental, theory-based physical activity counseling intervention for adults with type 2 diabetes.2011
Community Diabetes Education (CoDE) for uninsured Mexican Americans: a randomized controlled trial of a culturally tailored diabetes education and management program led by a community health worker.2013
Assessment of group versus individual diabetes education: a randomized study.2002
Improved control of type 2 diabetes mellitus: a practical education/behavior modification program in a primary care clinic.1999
Weight loss, glycemic control, and cardiovascular disease risk factors in response to differential diet composition in a weight loss program in type 2 diabetes: a randomized controlled trial.
Diabetes self-management among low-income Spanish-speaking patients: a pilot study.2005
Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income latinos: latinos en control.2011
Supporting diabetes self-care in underserved populations: a randomized pilot study using medical assistant coaches.2010
Medical assistant coaching to support diabetes self-care among low-income racial/ethnic minority populations: randomized controlled trial.2014
Effect of a brief, regular telephone intervention by paraprofessionals for type 2 diabetes.2009
Effectiveness of PRECEDE model for health education on changes and level of control of HbA1c, blood pressure, lipids, and body mass index in patients with type 2 diabetes mellitus.2011
Impact of conversation map education tools versus regular care on diabetes-related knowledge of people with type 2 diabetes: A randomized, controlled study2013
A randomized trial of a church-based diabetes self-management program for African Americans with type 2 diabetes.-- Not Found --
Experience-based group education in Type 2 diabetes: a randomised controlled trial.2004
Biophysiologic outcomes of the Enhancing Adherence in Type 2 Diabetes (ENHANCE) trial.2012
Effectiveness of lifestyle counseling by certified expert nurse of Japan for non-insulin-treated diabetic outpatients: a 1-year randomized controlled trial.2007
Instruments to tailor care of people with type 2 diabetes.2009
Who can provide diabetes self-management support in primary care? Findings from a randomized controlled trial.2013
Outcomes from a diabetes self-management intervention for Native Hawaiians and Pacific People: Partners in Care.2013
Texas-Mexico border intervention by promotores for patients with type 2 diabetes.2008
Controlled trial of nursing interventions to improve health outcomes of older African American women with type 2 diabetes.-- Not Found --
Symptom-focused management for African American women with Type 2 diabetes: a pilot study.2005
Motivational interviewing to improve adherence to a behavioral weight-control program for older obese women with NIDDM. A pilot study.1997
Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial.2011
Are benefits from diabetes self-management education sustained?2013
Evaluation of the UCL diabetes self-management programme (UCL-DSMP): a randomized controlled trial.2005
Effects of a regular walking exercise program on behavioral and biochemical aspects in elderly people with type II diabetes.2012
Comparative effectiveness of peer leaders and community health workers in diabetes self-management support: results of a randomized controlled trial.2014
Biologic and quality-of-life outcomes from the Mediterranean Lifestyle Program: a randomized clinical trial.2003
Promoting couples collaboration in type 2 diabetes: the diabetes support project pilot data.2011
The effects of a culturally sensitive, empowerment-focused, community-based health promotion program on health outcomes of adults with type 2 diabetes.2014
Culturally tailored intervention for rural African Americans with type 2 diabetes.-- Not Found --
Effect of a group-based rehabilitation programme on glycaemic control and cardiovascular risk factors in type 2 diabetes patients: the Copenhagen Type 2 Diabetes Rehabilitation Project.2011
Buena Alimentacion, Buena Salud: a preventive nutrition intervention in Caribbean Latinos with type 2 diabetes.-- Not Found --
A feasibility study of a culturally tailored diabetes intervention for Mexican Americans.2007
Results of a successful telephonic intervention to improve diabetes control in urban adults: a randomized trial.2011
The effect of a structured behavioral intervention on poorly controlled diabetes: a randomized controlled trial.
Mexican American trial of community health workers: a randomized controlled trial of a community health worker intervention for Mexican Americans with type 2 diabetes mellitus.2014
Effects of a cognitive behavioural treatment in patients with type 2 diabetes when added to managed care; a randomised controlled trial.2013
Motivational interviewing improves weight loss in women with type 2 diabetes.
Life-style modification for weight control to improve diabetes health status.1994
Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes.2013
Integrative health coaching for patients with type 2 diabetes: a randomized clinical trial.2010
Translating lifestyle intervention to practice in obese patients with type 2 diabetes: Improving Control with Activity and Nutrition (ICAN) study.2004
The Effect of a Comprehensive Lifestyle Modification Program on Glycemic Control and Body Composition in Patients with Type 2 Diabetes2007
Motivational interviewing delivered by diabetes educators: does it improve blood glucose control among poorly controlled type 2 diabetes patients?2011
Long-term outcomes from a multiple-risk-factor diabetes trial for Latinas: Viva Bien!2011
A self-management intervention for African Americans with comorbid diabetes and hypertension: a pilot randomized controlled trial.2014
Long-term interactive group education for type 1 diabetic patients.2005
Impact of reinforcement of diabetes self-care on poorly controlled diabetes: a randomized controlled trial.2013
Results of the northern Manhattan diabetes community outreach project: a randomized trial studying a community health worker intervention to improve diabetes care in Hispanic adults.2014
Project SEED: Support, Education, and Evaluation in Diabetes 2013
Effectiveness of a self-management intervention in patients with screen-detected type 2 diabetes.
A Mobile Health Intervention for Self-Management and Lifestyle Change for Persons With Type 2 Diabetes, Part 2: One-Year Results From the Norwegian Randomized Controlled Trial RENEWING HEALTH.2014
A Virtual World Versus Face-to-Face Intervention Format to Promote Diabetes Self-Management Among African American Women: A Pilot Randomized Clinical Trial.2014
Effect of lifestyle modification on serum chemerin concentration and its association with insulin sensitivity in overweight and obese adults with type 2 diabetes.2014
Dyadic collaboration in shared health behavior change: the effects of a randomized trial to test a lifestyle intervention for high-risk Latinas.2014
Effect of hospital-based telephone coaching on glycaemic control and adherence to management guidelines in type 2 diabetes, a randomised controlled trial.2014
Nurse-Led Behavioral Management of Diabetes and Hypertension in Community Practices: A Randomized Trial.2015
The effect of diabetes self-management education on body weight, glycemic control, and other metabolic markers in patients with type 2 diabetes mellitus.2014
Motivational Interviewing to Improve Diabetes Outcomes in African Americans Adults With Diabetes.2014
Flexible Lifestyles for Youth (FL3X) behavioural intervention for at-risk adolescents with Type 1 diabetes: a randomized pilot and feasibility trial.2014
A randomized controlled trial of cognitive behaviour therapy to improve glycaemic control and psychosocial wellbeing in adolescents with type 1 diabetes.2014
Randomized controlled trial of a behavioral weight loss intervention for primary prevention of renal decline in Type 2 diabetics2014

Downloadable Data Content

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