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Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis

Steinsbekk, Aslak; Rygg, Lisbeth Østgaard; Lisulo, Monde; Rise, Marit By; Fretheim, Atle
Journal article, Peer reviewed
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URI
http://hdl.handle.net/11250/300547
Date
2012
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  • Institutt for samfunnsmedisin og sykepleie [2413]
  • Publikasjoner fra CRIStin - NTNU [26604]
Original version
BMC Health Services Research 2012, 12   10.1186/1472-6963-12-213
Abstract
Background: Diabetes self-management education (DSME) can be delivered in many forms. Group based DSME is

widespread due to being a cheaper method and the added advantages of having patient meet and discuss with

each other. The aid was to assess effects of group-based DSME compared to routine treatment on clinical, lifestyle

and psychosocial outcomes in type-2 diabetes patients.

Methods: A systematic review with meta-analysis. Computerised bibliographic database were searched up to

January 2008 for randomised controlled trials evaluating group-based DSME for adult type-2 diabetics versus

routine treatment where the intervention had at least one session and =/>6 months follow-up. At least two

reviewers independently extracted data and assessed study quality.

Results: In total 21 studies (26 publications, 2833 participants) were included. Of all the participants 4 out of 10

were male, baseline age was 60 years, BMI 31.6, HbA1c 8.23%, diabetes duration 8 years and 82% used medication.

For the main clinical outcomes, HbA1c was significantly reduced at 6 months (0.44% points; P = 0.0006, 13 studies,

1883 participants), 12 months (0.46% points; P = 0.001, 11 studies, 1503 participants) and 2 years

(0.87% points; P<0.00001, 3 studies, 397 participants) and fasting blood glucose levels were also significantly

reduced at 12 months (1.26 mmol/l; P<0.00001, 5 studies, 690 participants) but not at 6 months. For the main

lifestyle outcomes, diabetes knowledge was improved significantly at 6 months (SMD 0.83; P = 0.00001, 6 studies,

768 participants), 12 months (SMD 0.85; P<0.00001, 5 studies, 955 participants) and 2 years (SMD 1.59; P = 0.03,

2 studies, 355 participants) and self-management skills also improved significantly at 6 months (SMD 0.55; P = 0.01,

4 studies, 534 participants). For the main psychosocial outcomes, there were significant improvement for

empowerment/self-efficacy (SMD 0.28, P = 0.01, 2 studies, 326 participants) after 6 months. For quality of life no

conclusion could be drawn due to high heterogeneity. For the secondary outcomes there were significant

improvements in patient satisfaction and body weight at 12 months for the intervention group. There were no

differences between the groups in mortality rate, body mass index, blood pressure and lipid profile.

Conclusions: Group-based DSME in people with type 2 diabetes results in improvements in clinical, lifestyle and

psychosocial outcomes.

Keywords: Patient education as topic, Self-care, Type 2 diabetes mellitus, Systematic review.
Publisher
BioMed Central
Journal
BMC Health Services Research

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