Supported self-management for people with type 2 diabetes: a meta-review of quantitative systematic reviews. (November 2017)

• Record Type: Journal Article
• Authors: Captieux, Mireille; Pearce, Gemma; Parke, Hannah; Wild, Sarah; Taylor, Stephanie J C; Pinnock, Hilary
• Is Part Of: Lancet. Volume 390(2017)Supplement 3
• Page Start: S32
• Publication Date: 2017-11
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(17)32967-7
• Languages: English
• ISSNs: 0140-6736

Abstract

Abstract: Background: Self-management support aims to give people with chronic disease confidence in taking an active role in all aspects of their disease management and choosing healthy behaviours. Our meta-review of systematic reviews of randomised controlled trials (RCTs) examined self-management support interventions for people with type 2 diabetes. We aimed to answer questions of importance to health-care systems: does self-management support improve outcomes for people with type 2 diabetes, and which of these interventions work and for whom? Methods: Adapting Cochrane methodology, we combined terms for "self-management support" AND "diabetes" AND "systematic review" restricted to the English language. We searched seven electronic databases: Medline, EMBASE, CINAHL, PsycINFO, AMED, BNI, and Cochrane Database of Systematic Reviews/DARE from Jan 1, 1993, to Oct 5, 2016. A pre-publication update to April 7, 2017, was undertaken by forward citation on included reviews (ISI Proceedings). We undertook screening, data extraction, and assessed quality with R-AMSTAR. Our primary outcome was glycaemic control. Composition, delivery, and setting of interventions were coded with the PRISMS taxonomy of self-management support. Synthesis was narrative; results of included reviews' meta-analyses were illustrated with meta-forest plots. Findings: Including original and update searches (28 143 titles) we identified 39 systematic reviews incorporating data from 459 unique RCTs across 33 countries. R-AMSTAR score range was 23–42 (highest quality being 44). There was consistent evidence that self-management support improved glycaemic control (pooled glycated haemoglobin [HbA1c ] mean difference in 20 meta-analyses −0·10% to −1·19%). Short term improvement (6 month HbA1c range −0·06% to −0·53%) was attenuated at 12 and 24 months. A wide variety of self-management support components were used, most commonly information about type 2 diabetes and its management, psychological, lifestyle, and social support strategies. No single approach appeared optimally effective (or ineffective). Self-management support improved glycaemic control when delivered to demographically or culturally diverse populations, using different modes of delivery by a range of professional and lay people. Technology-facilitated self-management support showed similar impact on HBA1c (mean difference −0·21% to −0·6%). Interpretation: Self-management support for type 2 diabetes consistently improves short-term glycaemic control. The intervention consisted of a range of components and modes of delivery in a variety of settings for a global and culturally diverse population with type 2 diabetes. Focus should now shift to addressing implementation and sustainability in routine care. Funding: National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) programme (project number 11/1014/04).