Behavioral Programs for Diabetes Mellitus

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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 36.4 (32.8-41.8) kg/m 2 7.1 (6.3-7.4)%, 0% Davis, 2010 I= 85 UC= 80 (Median, IQR) I= 59.9±9.4y 27.1%, 75.3% 37.1±8.1kg/m 2 9.3±1.9%, 16.3% DSME; Diabetes TeleCare for underserved communities 12m; 13, NR; NA Mixed Mixed Multidisciplinary (RN/CDE, RD, LPN) Moderate-to- High – Content & Delivery Yes Deakin, 2006 I= 157 Att. C= 157 D’Eramo- Melkus, 2010 U.S. (CT) I= 52 AC= 57 UC= 59.2±9.3y 23.7%, 72.5% 35.9±7.6 kg/m 2 8.9±1.8%, 22.8% I= 61.3±9.7y 52%, NR 30.8±5.3kg/m 2 7.7±1.6%, 17% Att. C= 61.8±11.0y 52%, NR 30.6±5.7kg/m 2 7.7±1.6%, 17% I= 45±10y 0%, 100% 96±18kg 8.3±2.2%, 0% I= DSME; X-PERT Programme focused on empowerment and discovery learning Att. C= 3 booked contacts for RD, RN and GP I= DSME + Support; culturally relevant CBTbased behavioral DSMT plus coping I= 1.5m; 6, 12h; NA Att. C= 1.5m; 1- 3, 1h; NA I= 12m; 13, 12.5h+3 NP support visits; 9m AC= 12m; 14, I= In-person Att. C= Inperson I= In-person AC= Inperson I= Group with supports Att. C= Inperson I= Mixed AC= Mixed I= HCP (RD) Att. C= Multidisciplinary (RD, RN, GP) I= Multidisciplinary (NP, Psych) AC= HCP (NP) I= Moderateto-High – Content & Delivery Att. C= Minimal - Content I= Moderateto-High – Content AC= None I= Yes Att. C= None/NR I= None/NR AC= None/NR F-20
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 Dunstan, 1997 Australia Dunstan, 2005 Australia I= 11 AC= 12 I= 19 AC= 17 AC= 45±10y 0%, 100% 96±18kg 8.3±2.2%, 0% I= 52.3±8.3y 73%, NR 29.1±2.4kg/m 2 8.8±2.7%, 0% AC= 53.0±7.0y 75%, NR 29.7±4.3kg/m 2 8.1±1.4%, 0% I= 67.6±5.2y 63%, NR 31.5±3.4kg/m 2 8.1±1.1%, 0% AC= 66.9±5.3y 46%, NR 32.5±3.8kg/m 2 7.5±1.1%, 0% skills training and followup support AC= Non-DSME education and support I= Lifestyle; lowfat diet with supervised moderate intensity stationary cycling 3x/wk for older adults AC= Diet; low fat diet with supervised stretching 3x/wk I= Lifestyle; moderate weight loss diet plus supervised and home-based high intensity (75-85% 1-RM) progressive resistance training AC= Diet; moderate weight loss diet with supervised and home-based 17+3 NP support visits; 9m I= 1.8m; 24, 16h+weekly RD interview duration; NA AC= 1.8m; 24, 16h+weekly RD interview duration; NA I= 12m; 86, 72h+ time for 14 calls; 6m AC=12m; 86, 72h+ time for 14 calls; 6m I= In-person AC= Inperson I= Mixed AC= Mixed I= Individual AC= Individual (NR for PA component) I= Individual AC= Individual I= Multidisciplinary (RD, Exercise physiologist) AC= Multidisciplinary (RD, Exercise physiologist) I= Multidisciplinary (RD, Exercise physiologist) AC= Multidisciplinary (RD, Exercise physiologist) I= Minimal – Content AC= Minimal - Content I= Minimal – Content & Delivery AC= Minimal – Content & Delivery I= None/NR AC= None/NR I= None/NR AC= None/NR F-21
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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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Appendix D. Studies Excluded After
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Health. 2006;6:134. PMID: 16709243.
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November/December;24(9):450-6. PMID
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89. Dinneen SF, O'hara MC, Byrne M,
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119. Fitzpatrick SL, Jeffery R, Joh
Page 183 and 184: Aug;19(8):835-42. PMID: 8842601. Ex
Page 185 and 186: adherence and metabolic control. Di
Page 187 and 188: May;36(5):1297-303. PMID: 23223405.
Page 189 and 190: 244. Korytkowski MT, Koerbel GL, Ko
Page 191 and 192: 275. Maljanian R, Grey N, Staff I,
Page 193 and 194: 306. Naccashian Z. The impact of di
Page 195 and 196: led structured program on blood glu
Page 197 and 198: Engineering. 2014;75(1-B E). PMID:
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
Page 213 and 214: Ridgeway, 1999 M M H M H L H H M L
Page 215 and 216: Appendix F. Description of Studies
Page 217 and 218: Author, Year & Country Comparison &
Page 225 and 226: Table F3. Description of studies an
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Page 277 and 278: Appendix H. Strength of Evidence Ta
Page 279 and 280: Outcome # Trials (# Subjects); Tool
Page 281 and 282: Table H3. Behavioral programs compa
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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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