Supported self-management for people with type 2 diabetes: a meta-review of quantitative systematic reviews

Abstract

Objectives: Self-management support aims to give people with chronic disease confidence to actively manage their disease, in partnership with their healthcare provider. A meta-review can inform policy-makers and healthcare managers about the effectiveness of self-management support strategies for people with type 2 diabetes, and which interventions work best and for whom.

Design: A meta-review of systematic reviews of randomised controlled trials (RCTs) was performed adapting Cochrane methodology.

Setting and participants: Eight databases were searched for systematic reviews of RCTs from January 1993 to October 2016, with a pre-publication update in April 2017. Forward citation was performed on included reviews in Institute for Scientific Information (ISI) Proceedings. We extracted data and assessed quality with the Revised-Assessment of Multiple Systematic Reviews (R-AMSTAR).

Primary and secondary outcome measures: Glycaemic control as measured by glycated haemoglobin (HbA1c) was the primary outcome. Body mass Index, lipid profiles, blood pressure and quality of life scoring were secondary outcomes. Meta-analyses reporting HbA1c were summarised in meta-forest plots; other outcomes were synthesised narratively.

Results: 41 systematic reviews incorporating data from 459 unique RCTs in diverse socio-economic and ethnic communities across 33 countries were included. R-AMSTAR quality score ranged from 20 to 42 (maximum 44). Apart from one outlier, the majority of reviews found an HbA1c improvement between 0.2% and 0.6% (2.2-6.5 mmol/mol) at 6 months post-intervention, but attenuated at 12 and 24 months. Impact on secondary outcomes was inconsistent and generally non-significant. Diverse self-management support strategies were employed; no single approach appeared optimally effective (or ineffective). Effective programmes tended to be multi-component and provide adequate contact time (>10 hours). Technology-facilitated self-management support showed a similar impact as traditional approaches (HbA1c MD -0.21% to -0.6%).

Conclusions: Self-management interventions using a range of approaches improve short-term glycaemic control in people with type 2 diabetes including culturally diverse populations. These findings can inform researchers, policy-makers and healthcare professionals re-evaluating the provision of self-management support in routine care. Further research should consider implementation and sustainability.

Keywords: Supported Self-management; health policy; meta-review; primary care; quality In health care.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.

Figure 2

Meta-Forest plot of mean difference in HbA1c (variable time-points).

Figure 3

Meta-Forest plot of mean difference in HbA1c according to duration of follow-up a: Mean difference in HbA1c at follow-up ≤ 6months b: Mean difference in HbA1c at follow-up >6months to ≤ 12months c: Mean difference in HbA1c at follow-up >12months to ≤24months. RCT, randomised controlled trial.