Effectiveness of self management training in type 2 diabetes - A systematic review of randomized controlled trials

OBJECTIVE - To systematically review the effectiveness of self-management t raining in type 2 diabetes. RESEARCH DESIGN AND METHODS - MEDLINE, Educational Resources Information Ce nter (ERIC), and Nursing and Allied Health databases were searched for Engl ish-language articles published between 1980 and 1999. Studies were origina l articles reporting the results of randomized controlled trials of the eff ectiveness of self-management training in people with type 2 diabetes. Rele vant data on study design, population demographics, interventions, outcomes , methodological quality, and external validity were tabulated, interventio ns were categorized based on educational focus (information, lifestyle beha viors, mechanical skills, and coping skills), and outcomes were classified as knowledge, attitudes, and self-care skills, lifestyle behaviors, psychol ogical outcomes, and quality of life; glycemic control; cardiovascular dise ase risk factors; and economic measures and health service utilization. RESULTS- A total of 72 studies described in 84 articles were identified for this review. Positive effects of self-management training on knowledge, fr equency and accuracy of self-monitoring of blood glucose, self-reported die tary habits, and glycemic control were demonstrated in studies with short f ollow-up (<6 months). Effects of interventions on lipids, physical activity , weight, and blood pressure were variable. With longer follow-up, interven tions that used regular reinforcement throughout Follow-up were sometimes e ffective in improving glycemic control. Educational interventions that invo lved patient collaboration may be more effective than didactic intervention s in improving glycemic control, weight, and lipid profiles. No studies dem onstrated the effectiveness of self-management training on cardiovascular d isease-related events or mortality no economic analyses included indirect c osts; few studies examined healthcare utilization. Performance, selection, attrition, and detection bias were common in studies reviewed, and external generalizability was often limited. CONCLUSIONS - Evidence supports the effectiveness of self-management traini ng in type 2 diabetes, particularly in the short term. Further research is needed to assess the effectiveness of self-management interventions on sust ained glycemic control, cardiovascular disease risk factors, and ultimately , microvascular and cardiovascular disease and quality of life.