Effects
of Self-Management Education on Glycemic Control
Increased
contact time increases the benefits and effects outcomes.
The
object of the study was to evaluate the efficacy of self-management
education on A1c in adults with type 2 diabetes.
We
searched for English language trials in Medline
(1980–1999), Cinahl (1982–1999), and the Educational
Resources Information Center database (ERIC) (1980–1999),
and we manually searched review articles, journals with
highest topic relevance, and reference lists of included
articles.
Studies
were included if they were randomized controlled trials
that tested the effect of self-management education on adults with
type 2 diabetes, and reported extractable data on the effect
of treatment on A1c. A total of 31 studies of 463 initially
identified articles met selection criteria. We computed net
change in A1c, stratified by follow-up interval, tested for
trial heterogeneity, and calculated pooled effects sizes using
random effects models. We examined the effect of baseline A1c,
follow-up interval, and intervention characteristics on A1c.
What
was found was that on average, the intervention decreased A1c by 0.76%
(95% CI 0.34–1.18) more than the control group at immediate
follow-up; by 0.26% (0.21% increase - 0.73% decrease) at
1–3 months of follow-up; and by 0.26% (0.05–0.48) at
4
months of follow-up. A1c decreased more with additional contact
time between participant and educator; a decrease of 1% was
noted for every additional 23.6 h (13.3–105.4) of
contact.
It
was concluded that self-management education improves A1c levels at
immediate follow-up, and increased contact time increases the
effect. The benefit declines 1–3 months after the intervention
ceases, however, suggesting that learned behaviors change
over time. Further research is needed to develop interventions effective
in maintaining long-term glycemic control.
Diabetes Care
25:1159-1171, 2002
