Effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes: a systematic review

Abstract

Executive summary: Background As a chronic condition, the prevalence of Type 2 diabetes is increasing worldwide and adherence to oral medications, an essential component of self-management, has been shown to improve glycaemic control. However compliance with oral medication adherence remains poor. Educating people with Type 2 diabetes is an important strategy to enhance self-management ability, including medication-taking behaviour.Objectives The overall objective of the review was to determine the effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes.

Inclusion criteria: Types of participants Studies involving adults over 18 years old with Type 2 diabetes, with or without co-morbidities, currently taking oral hypoglycaemic medication without insulin treatment, and with aglycated haemoglobin (HbA1c) > 7.0% prior to the intervention were considered. Aglycated haemoglobin (HbA1c) concentration of less than 7.0%, is important in order to delay or prevent diabetes-related complications. Participants could be from the primary, tertiary or acute care setting.Types of intervention The review focused on various forms of educational interventions delivered by healthcare professionals aimed at improving participants' knowledge.Types of outcomes The review evaluated outcomes measuring oral hypoglycaemic adherence including HbA1c, fasting blood glucose levels and other relevant indicators.Types of studies Studies that were randomized controlled trials (RCTs) or case-control studies were considered.Search strategy A three-stage search strategy was employed. Papers in English and between the years 1990-2009 were searched in the following databases: CINAHL, Medline, Mosby's Nursing Consult, PsycINFO, PubMed, ScienceDirect, Scopus, TRIP and Web of Science. Full text was retrieved when the titles and abstracts of studies fulfilled the inclusion criteria.Methodological quality Full papers were assessed for methodological quality independently by two reviewers using critical appraisal checklists from the Joanna Briggs Institute (JBI). A third reviewer was consulted whenever there were disagreements between the two reviewers.Data collection/extraction Details of each study included in the review were extracted using standardized data extraction forms developed by JBI. Extraction was conducted independently by two reviewers.Data synthesis Meta-analysis was not possible due to methodological and statistical heterogeneity of the included studies. Hence study findings are presented in narrative form.Results Seven studies included in the final review consisted of seven RCTs. Five studies concluded that the educational intervention was effective in promoting oral hypoglycaemic adherence compared to usual care. These included pharmacist-led interventions, individual diabetes education provided by nurses and diabetes group education based on a self-management approach. Similarities among these interventions were provision of information on oral hypoglycaemic medication and the need for regular education sessions. However, small samples in some studies limited generalization of results.

Conclusions: Implications for practice Increased knowledge of oral hypoglycaemic issues and reinforcement of the importance of medication adherence were useful in promoting adherence. Regular education sessions allow individuals to reinforce information and educators to identify barriers to medication adherence. Educational interventions focusing on self-management strategies appear more likely to achieve positive outcomes.Implications for research Further trials involving larger samples and populations with poor glycaemic control are needed. The effects of educational interventions, influence of additional take-home written material, the optimal interval length of follow-up and duration of education sessions, and specific processes of individual or group education which have been identified as effective need further exploration.