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 AC 2= 58.5±1.7y 0%, NR 34.3±1.9kg/m 2 7.3±0.5%, 0% AC 1= PA control AC 2= Diet control Glasgow, 2006a U.S. (CO) Glasgow, 2006b U.S. (CO) Glasgow, 2012 U.S. (CO) I= 174 Att. C= 161 I= 167 UC= 160 I= 162 AC= 169 Att. C= 132 I= 62.0±11.7y 49.7%, 25.9% 31.3±7.0kg/m 2 7.4±1.6%, 24.2% Att. C= 61.0±11.0y 50%, 20.4% 31.9±7.2kg/m 2 7.5±1.6%, 19.2% I= 61.1±11.4y 50%, 34% 32.1±7.0kg/m 2 7.3±1.5%, 27% UC= 61.1±11.4y 60%, 27% 33.3±8.0kg/m 2 7.2±1.3%, 22% I= 57.8±9.3y 46.3%, 29.3% 35.3±0.5kg/m 2 8.3±0.1%, NR I= DSME; CBTbased computerassisted tailored intervention focused on healthy eating and PA with followup Att. C= computergenerated general health risk appraisal with brief followup and counseling DSME; computerassisted and tailored DSM intervention focused on diet and aerobic and strength PA I= DSME; My Path to Healthy Life, bilingual computer-assisted I= 2m; 3, 1h+; NA (Plus tailored mail out) Att. C= NR I= Mixed Att. C= Mixed I= Individual Att. C= Individual I= Non-HCP (health educators) Att. C= Non-HCP (health educators) 2m; 4, 1.5h; NA Mixed Individual Non-HCP (graduates of health degrees) I= 12m; 3+, 1h+; NA (Plus computer I= Mixed AC= NA I= Mixed AC= Individual I= Non-HCP (research staff member) & HCP (RD) I= Minimal – Content & Delivery Att. C= NA Moderate-to- High – Content I= Moderateto-High – Content & Delivery I= None/NR Att. C= NA None/NR I= Yes AC= Yes F-26
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 AC= 58.7±9.3y 55.4%, 25.9% 34.4±0.5kg/m 2 8.0±0.1%, NR Att. C= 58.7±9.1y 48.5%, 29.4% 34.8±0.6kg/m 2 8.2±0.2%, NR self-management program (CASM) focused on diet, PA and medication taking with followup calls and group sessions AC= Non-DSME education via (CASM) with periodic automated motivational calls use and invitation to 3- 2h group sessions but only 36% attended one) AC= 12m; NA (Computer use only) Att. C= 12m; NR Att. C= Technology Att. C= Individual AC= NA Att. C= NR AC= Moderate-to- High – Content & Delivery Att. C= NA Att. C= NA Goudswaard, 2004 The Netherlands Hawkins, 2010 U.S. (CT) I= 28 UC= 30 I= 40 Att. C= 36 I= 62.6±9.0y 52%, NR 30.2±4.4 8.2±1.1%, 0% UC= 58.7±11.4y 44%, NR 29.8±5.5 8.8±1.5%, 0% I= 64y 14.7%, 82.4% Att. C= Tailored health risk assessment and brief contacts DSME; collaborative education with emphasis on SMBG interpretation <strong>for</strong> patients on maximal oral hypoglycemic agents I= DSME; videophone 6m; 6, 2.5h; NA In-person Individual HCP (RN) Minimal - Content I= 6m; 16, 4.5h; NA I= Technology I= Individual I= HCP (NP) I= Moderateto-High – None/NR I= None/NR F-27
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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
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Aug;19(8):835-42. PMID: 8842601. Ex
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adherence and metabolic control. Di
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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
Page 239: Author, Year & Country Comparison &
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
Page 283 and 284: 16. Mayer-Davis EJ, Seid M, Crandel
Page 285 and 286: Table I1. Effectiveness of behavior
Page 287 and 288: Category Health Outcomes Outcomes A
Page 289 and 290: 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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