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 Canada AC= 19 42%, NR 32.7±5.9kg/m 2 6.5±1.3%, 0% AC= 56.2y 42%, NR 32.0±6.2kg/m 2 6.4±1.3%, 0% walking program with supervised walking 1x/wk and goal to increase intensity by 10% and diet training to exchange foods having low for high glycemic index AC= 3m; 8, NR (All participants received 12- week basic walking program in early phase) AC= Inperson AC = Group (health field graduate students) AC= non-HCP Content AC= Minimal - Content None/NR AC= None/NR Jones, 2003 Canada Keyserling, 2002 U.S. (NC) I= 250 UC= 250 (Not reporting on groups receiving free glucose testing strips) I 1= 66 I 2= 67 UC= 67 I= 55.1y 56.4%, NR 32.2kg/m 2 8.43%, 32% UC= 54.6y 50%, NR 31.6kg/m 2 8.48%, 34.4% I 1= 59.8y 0%, 100% 34.6kg/m 2 11.1%, 40.9% AC= basic walking program (no defined targets) and basic dietary education on glycemic load DSME; Pathways to Change, stagematched personalized assessment and counseling for SMBG, healthy eating and smoking cessation I 1= Lifestyle; clinicbased with diet (reduced fat), PA (30mins/ day) 12m; 5, NR; NA (Plus newsletters) I 1= 6m; 4, 3h; NA I 2= 12m; 19, 9.5h; 6m Technology Individual NR Moderate-to- High – Content & Delivery I 1= Individual I 2= Mixed I 1= Individual I 2= Mixed I 1= HCP (RD) I 2= Non-HCP (peer) & HCP I 1= Minimal – Content & Delivery None/NR I 1= None/NR I 2= Yes F-32
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 Kim, 2006 Korea Kim, 2009 U.S. (MD, DC) Kim, 2014 Korea I= 32 UC= 26 I= 41 UC= 42 I = 18 UC = 17 I 2= 58.5y 0%, 100% 36.2kg/m 2 10.8%, 43.3% UC= 59.2y 0%, 100% 36.5kg/m 2 11.3%. 41.8% I= 55.0±8.1y 19%, NR 25.8±3.8kg/m 2 8.5±1.4%, NR UC= 53.8±9.0y 31%, NR 26.2±4.0kg/m 2 8.6±1.3%, NR I= 56.2±8.4y 62.5%, 100% 25.9±3.4kg/m 2 9.4±1.5%, NR UC= 56.6±7.6y 48.7%, 100% 25.7±3.1kg/m 2 9.1±1.3%, NR I= 48.8±8.6y 50%, NA 28.3±3.4kg/m 2 I 2= Lifestyle; clinic and communitybased A New Leaf . Choices for Healthy Living with Diabetes for African American Women incorporating social support Lifestyle; education and counseling for 5% weight loss including individualized diet and ≥150mins/wk moderate PA DSME + Support; community-based SHIP-DM (selfhelp intervention program for type 2 diabetes management) for Korean American immigrants Lifestyle; diet and PA prescription with supervised (RD) 6m; 18, NR; 2m In-person Individual Non-HCP (exercise trainer) & HCP (RN) 7m; 12, 13-15h; 5.6m (Plus reminder calls and newsletters) Mixed Mixed Multidisciplinary (RD, RN) 3m; 36, 36h+; NA In-person Individual Multidisciplinary (RD, exercise physiologist) I 2= Moderateto-High – Content & Delivery Minimal – Content & Delivery Moderate-to- High - Delivery Minimal - Content None/NR Yes None/NR F-33
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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.
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244. Korytkowski MT, Koerbel GL, Ko
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275. Maljanian R, Grey N, Staff I,
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306. Naccashian Z. The impact of di
Page 195 and 196: led structured program on blood glu
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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
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 245: 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
Page 291 and 292: Category Outcomes Timepoint Health
Page 293 and 294: Outcome Change in Body Composition
Page 295 and 296: 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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