Issue 116 Item 14 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