Behavioral Programs for Diabetes Mellitus

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Author, Year & Country Comparison & Sample Size Age, Males, Ethnic Minorities, HbA1c Intervention Category & Description Total Duration, # Contacts, Contact Time Method of Communication (In-person, Mixed, Technology) Method of Delivery (Individual, Group, Mixed) Delivery Personnel (Non-HCP, Single HCP, Multidisciplinary) Degree of Tailoring Community Engagement Zoffmann, 2006 Denmark I= 36 UC= 25 AC 2= 56.2 (21.6-74.8)y 42%, 15% 8.6 (7.6-13.1)%, 49% I= 36.8±1.7y, 46.5%, NR, 9.0±0.2% UC= 35.7±2.1y, 50%, NR, 9.1±0.2% RD consults offered) DSME; Guided Self-Determination Group Training 2m, 8, 16h In-person Group Multidisciplinary (RN & researcher) Content & Delivery Moderateto-High – Content & Delivery AC= active control; CBT= cognitive behavioral therapy; CDE= certified diabetes educator; CGMG= continuous glucose monitoring system; DSME= diabetes self-management education; DSN= diabetes specialist nurse; HCP= health care professional; I= Intervention; NA= not applicable; NR= not reported; Observ.= observational design; Psych= psychologist; RD= registered dietitian; RN= registered nurse; SMBG= self-monitoring blood glucose; UC= usual care None/NR F-10
Table F3. Description of studies and interventions <strong>for</strong> T2DM Author, Year & Country Comparison & Sample Size (Number randomized unless NR then # analyzed) Age, Male, Non-White, BMI/KG, HbA1c, Insulin Treatment Intervention Category & Description Total Duration Including all Phases (m); Intensity (# contacts, total contact time); Maintenance/Support Phase Duration Method of Communication (In-person, Mixed, Technology) Method of Delivery (Individual, Group, Mixed) & Presence of Supports Delivery Personnel (Non- HCP, Single HCP, Multidisciplinary) Degree of Tailoring Community Engagement Adachi, 2013 Japan Adolfsson, 2007 Sweden I= 100 UC= 93 I= 50 UC= 51 I= 60.4±11.4y 45%, NR 26.3±4.6kg/m 2 7.6±1.4%, 11% UC= 62.3±10.1y 42%, NR 24.9±4.6kg/m 2 7.3±1.1%, 13% I= 62.4±8.9y 57%, NR 30.4±4.3 7.4±1.0%, 0% DSME; SILE (Structured Individual-based Lifestyle Education), focus on diet but also self-management through activity and stress management DSME; empowerment group education 6m; 3.5; NR; NA In-person Individual HCP (RD) Moderate-to- High – Content 7m; 4.7, 12h; NA In-person Group Multidisciplinary (DSN, Physician) Moderate-to- High – Content & Delivery None/NR None/NR Agurs-Collins, 1997 U.S. (DC) I= 32 UC= 32 UC= 63.7±9.0y 61%, NR 29.6±3.3kg/m 2 7.1±0.8%, 0% I= 62.4±5.9y 34%, 100% 33.9±5.1kg/m 2 11.0±1.7%, 40% UC= 61.0±5.7y 12%, 100% 34.9±6.8kg/m 2 10.0±1.9%, 50% Lifestyle; hospitalbased lifestyle program (Diabetic Exchange Lists) to achieve ≤0.9kg wt loss/wk & moderate physical activity ≥3 x/wk with weekly group exercises <strong>for</strong> 3m) tailored to older African Americans 6m; 19, 28h; 3m In-person Mixed with supports HCP (RD) Minimal from exercise physiologist Moderate-to- High – Content & Delivery None/NR F-11
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Evidence Report/Technology Assessme
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This report is based on research co
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Key Informants In designing the stu
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Peer Reviewers Prior to publication
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HbA 1c reduction were more often de
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KQ 6. Subgroups for Factors Moderat
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Figure 13. Behavioral programs for
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glycemia in reducing the incidence
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together with one or more additiona
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Figure A. Analytic framework for be
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Methods Literature Search Strategy
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With input from our Technical Exper
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participants had suboptimal baselin
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duration of diabetes ranged from 2.
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Table B. Type 1 diabetes: summary o
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T2DM: Description and Risk of Bias
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Figure D. Plot of network meta-anal
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The positive findings for behaviora
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elated to the Human Development Ind
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Table D. Potential research needs b
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References 1. Renders CM, Valk GD,
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37. Chodosh J, Morton SC, Mojica W,
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Introduction Background The high bu
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Factors other than blood glucose co
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may include interventions related t
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programs. The overarching boxes (co
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Figure 2. Analytic framework for be
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American Diabetes Association, Amer
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Table 1. Inclusion criteria for typ
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S1 in the Supplementary File). The
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clinically significant); we refer t
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Synthesis for T1DM (KQs 1-4) KQ 1:
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conducted for HbA 1c and body mass
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Applicability We followed the Metho
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Type 1 Diabetes Mellitus This secti
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therapy, 90,99,108 motivational enh
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and a peer (with diabetes and train
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followup (low SOE for both); there
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Figure 6. Behavioral programs for t
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similar results were found for yout
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HbA 1c : Comparative Effectiveness
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Two trials reported on adherence to
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Table 4. Other clinical and behavio
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Figure 14. Behavioral programs for
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Health-Related Quality of Life: Beh
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estimated effects were imprecise an
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Table 8. Type 1 diabetes: summary o
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Summary of Key Findings and Strengt
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studies 82,94,95,105,109,112 were n
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studied a DSME program in patients
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I 2 =74%), 135,137,139,141,142,145,
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Aerobic Fitness Test which estimate
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Key Points: Body Mass Index • Lif
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Table 12. Network meta-analysis for
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Figure 20. Plot of network meta-ana
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active comparator (20 trials, 7,709
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Discussion Key Findings and Discuss
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to be tempered by the findings of n
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compared with usual care. There was
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Our finding that single-topic, non-
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In their systematic review and meta
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For studies targeting adults, the m
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environmental contextual factors—
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assessors was also rarely reported,
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Tailoring programs to ethnic minori
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17. Centers for Disease Control and
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53. Medical Advisory Secretariat. B
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88. Ellis DA, Templin T, Naar-King
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122. Nansel TR, Iannotti RJ, Simons
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158. Cooper H, Booth K, Gill G. A t
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191. Koo BK, Han KA, Ahn HJ, et al.
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224. Sevick MA, Korytkowski M, Ston
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260. Yuan C, Lai CW, Chan LW, et al
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295. Ayling K, Brierley S, Johnson
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Appendix A. Operational Definitions
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the structured diet or physical act
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Appendix B. Literature Search Strat
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1. MeSH descriptor: [Diabetes Melli
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35. “blood glucose” N2 monitor*
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35. (behavio?r adj2 therap*).mp. 36
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52. exp animals/ not humans.sh. 53.
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57. "Follow-Up Studies"[Mesh] 58. "
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URL provided by Michelle Crain, AAD
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WHO ICTRP Trial Registry: WHO ICTRP
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Page 175 and 176: Health. 2006;6:134. PMID: 16709243.
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Page 181 and 182: 119. Fitzpatrick SL, Jeffery R, Joh
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Page 185 and 186: adherence and metabolic control. Di
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Page 189 and 190: 244. Korytkowski MT, Koerbel GL, Ko
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Page 193 and 194: 306. Naccashian Z. The impact of di
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Page 199 and 200: 395. Skoro-Kondza L, Tai SS, Gadelr
Page 201 and 202: 426. Torbjornsen A, Jenum AK, Smast
Page 203 and 204: Americans with type 2 diabetes. J A
Page 205 and 206: patients. Diabetes Res Clin Pract.
Page 207 and 208: Table E1. Risk of bias for studies
Page 209 and 210: Weinger, 2011 L M NA M NA L NA L L
Page 211 and 212: Cramer, 2007 M M H M H L H H L M H
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Page 215 and 216: Appendix F. Description of Studies
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Author, Year & Country Comparison &
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Appendix H. Strength of Evidence Ta
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Outcome # Trials (# Subjects); Tool
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Table H3. Behavioral programs compa
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16. Mayer-Davis EJ, Seid M, Crandel
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Table I1. Effectiveness of behavior
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Category Health Outcomes Outcomes A
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Table I2. Effectiveness of behavior
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Category Outcomes Timepoint Health
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Outcome Change in Body Composition
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Outcome Change in Physical Activity
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References for Appendix I 1. Adachi
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32. Rock CL, Flatt SW, Pakiz B, et
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follow-up study. Diabetes Res Clin
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98. Johnson ST, Bell GJ, Mccargar L
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Appendix J. Network Meta-Analysis R
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5 11-26h In person Group only NA -0
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9 11-26h In person Group only NA -0
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Behavioral Programs for Diabetes Mellitus

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