The effectiveness of patient-centered care vs. usual care in type 2 diabetes self-management: A systematic review and meta-analysis

Abstract

Background: Patient-centered care in diabetes self-management might be a significant factor in improving health outcomes of adults with type 2 diabetes, yet the supporting evidence is inadequate. This review aimed at assessing the effectiveness of patient-centered self-management care interventions on glycemic control (HbA1c) and self-care behaviors compared with usual care.

Methods: CINAHL, PubMed, Cochrane Library, Google Scholar, and the HEC Digital Library were searched for studies in English language that assessed patient-centered self-management educational and/or behavioral interventions in adults aged 18 years or older with type 2 diabetes from 2005 to 2020. Interventional studies with at least 3 months of follow-up and reporting on self-care outcomes such as glycemic control (HbA1c) and self-care behaviors including diet control, physical activity, foot care, and medication adherence were included.

Results: Of 168 identified records, 24 were found eligible comprising 20 RCTs and four QESs with total 4,083 participants. The meta-analysis involved 19 RCTs that provided enough information for a pooled estimate of HbA1c. Compared with the control group, patient-centered self-management interventions significantly lowered HbA1c, -0.56 (95% CI -0.79, -0.32). Stratified analysis for HbA1c with respect to various aspects of intervention showed larger effects in interventions employing both educational and behavioral components, -0.66 (95% CI -0.97, -0.34); spanned over shorter (<03 months) duration, -0.85 (95% CI -1.28, -0.43); administered by nurses, -0.80 (95% CI -1.44, -0.16); and delivered in community settings -0.70 (95% CI -1.14, -0.26).

Conclusion: This systematic review provided evidence supporting the effectiveness of patient-centered self-management care interventions in improving glycemic control and self-care behaviors in adults with type 2 diabetes and identified key features of intervention contributing toward success.

Keywords: HbA1c; education and counseling; meta-analysis; patient-centered care; self-management; type 2 diabetes.

Figure 1

PRISMA flow chart for study selection and reasons for exclusion.

Figure 2

(A) Quality of RCTs assessed by Rob 2. (B) Risk of bias summary RCTs.

Figure 3

(A) Quality of QESs assessed by using ROBINS-1. (B) Risk of bias summary QESs.

Figure 4

Forest plot of pooled effect size of HbA1c.

Figure 5

Funnel plot for publication bias in HbA1c effects.

Figure 6

(A) Pooled effect size of HbA1c in studies sub-grouped by components of intervention; (B) pooled effect size of HbA1c in studies sub-grouped by duration of intervention; (C) pooled effect size of HbA1c in studies sub-grouped by provider of intervention; (D) pooled effect size of HbA1c in studies sub-grouped by setting of intervention.