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DSME Programs are Not Enough

Oct 16, 2015
 

Behavioral programs for patients with diabetes provides benefit for glycemic control.

Researcher Jennifer Pillay, BSc, Edmonton Clinic Health Academy at the University of Alberta, and colleagues were interested in analyzing data to determine factors contributing to the efficacy of behavioral programs in T1DM and T2DM. Therefore, a meta-analysis was conducted to assess clinical and health outcomes in these individuals.

Investigators applied published data between 1993 and January 2015 for the study on T2DM, and data from 1993 to June 2015 for T1DM. Databases used include Ovid MEDLINE, EMBASE, PubMed and others. For the study on T1DM, data was analyzed from 35 prospective controlled studies.

In the T1DM study, researchers found that behavioral programs were beneficial for glycemic control. Moderate strength of evidence for behavioral programs showed greater reduction in HbA1C vs. standard care (mean difference = -0.29; 95% CI, -0.45-0.13) and controls (mean difference = -0.44; 95% CI, -0.69 to -0.19) after six months.  Considering this finding, researchers believe that T1DM patients should not be encouraged to join behavioral programs to improve outcomes apart from HbA1c as there is lacking evidence for greater clinical outcomes.

In the study for T2DM, researchers analyzed 132 randomized studies. Researchers found at least 0.4% reduction in HbA1c through lifestyle and diabetes management education (DSME) in addition to support programs that provided a minimum of 11 contact hours to these individuals.

Authors suggest that most DSME programs without the added support component provide minimal benefit, especially when less than 10 hours of contact was provided. However, most lifestyle and DSME programs in addition to support programs resulted in clinically important improvements in glycemic control. Lastly, patients with poor glycemic control found better benefit from these programs than patients with decent control.

Practice Pearls:

  • Program evaluation is an important factor for establishing any behavioral program for diabetes to ensure that it will be suitable for the target population.
  • Clinicians should still assess patients after participating in behavioral programs to control their disease more adequately and prevent future complications.
  • Lifestyle and DSME plus support programs providing at least 11 hours of contact may improve glycemic control in T2DM better than DSME programs alone.
  • In-person delivery programs are more effective than technology-based programs.

Pillay, Jennifer, et al. “Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis for Effect Moderation.” Annals of internal medicine (2015).