Supported self-management for people with type 2 diabetes: a meta-review of quantitative systematic reviews Mireille Captieux, Gemma Pearce, Hannah Parke, Sarah Wild, Stephanie J C Taylor, Hilary Pinnock
Abstract Published Online November 23, 2017 Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK (M Captieux MBChB, Prof S Wild PhD, Prof Hilary Pinnock MD); Centre for Technology Enabled Health Research, Coventry University, Coventry, UK (G Pearce PhD); and Multidisciplinary Evidence Synthesis Hub, Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK (Hannah Parke MSc, Prof S J C Taylor MD) Correspondence to: Dr Mireille Captieux, c/o Prof Hilary Pinnock, Old Medical School, Teviot Place, Edinburgh EH8 9AG, UK [email protected]
For the protocol of this meta-review see https://www. journalslibrary.nihr.ac.uk/ programmes/hsdr/11101404/#/
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). Contributors MC screened, extracted, and analysed the data for the update and wrote the report. HP screened, extracted, and analysed data for the initial meta-review. GP contributed to data screening, extraction, and analysis in both initial and update meta-review and oversaw the writing and revision of the report. SW oversaw the analysis and review of the update. SJCT and HP conceptualised the study design and secured funding for the original PRISMS study, and supervised the meta-review. All authors have seen and approved the final version of the abstract for publication. Declaration of interests We declare no competing interests. Acknowledgments MC is supported by the Scottish School of Primary Care (academic fellowship in general practice). The views and opinions expressed in this abstract are those of the authors and do not necessarily reflect those of the HS&DR programme, NIHR, National Health Service, or Department of Health.