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 McGowan, 2011 Canada Miller, 2014 U.S. (OH) I= 169 AC= 152 I= 32 AC= 36 10.2±2.5%, 51% UC= 62.4±9.5y 21%, 73.2% 35.2±7.5kg/m 2 9.6±2.9%, 41% I= 55±12y 46%, 22% 80±15kg 6.8±1.2%, NR AC= 59±12y 45%, 18% 83±19kg 7.1±1.5%, NR I= 54.0±7.0y 36%, 28% 36.2±1.2kg/m 2 8.3±0.3%, 0% AC= 53.9±8.2y 37%, 18.5% 36.2±1.2kg/m 2 8.5±0.2%, 0% intensive lifestyle program modeled after Diabetes Prevention Program tailored to medically underserved I= DSME; 2-day DM education and Stanford Chronic Disease Selfmanagement Program AC= 2-day DM education I= DSME; Smart Choices AC= Mindfulnessbased Eating Awareness Program with guided meditation I= 1.5m; 8, 27+h; NA AC= 0.06m; 2, 6+h; NA I= 6m; 12, 28h; NA AC= 6m; 12, 28h; NA I= In-person AC= Inperson I= In-person AC= Inperson I= Group AC= Group I= Group AC= Group I= Non-HCP (lay program leaders) & Multidisciplinary (RN, RD) AC= Multidisciplinary (RN, RD) I= HCP (RD) AC= Multidisciplinary (RD, social worker) I= Minimal – Content & Delivery AC= Minimal – Content I= Minimal – Content & Delivery AC= Minimal – Content & Delivery I= Yes AC= None/NR I= None/NR AC= None/NR Moncrieft, 2013 (Fl) I = 54 UC = 57 I= 54.8±8.3y 35.1%, 100% 32.2±3.7kg/m 2 7.7±1.4%, NR UC= 54.8±6.3y Lifestyle; Community Approach to Lifestyle Modification for Diabetes (CALM- 12m; 17; 26+h; 9m Plus brief telephone contact between Mixed Mixed Non-HCP (psychologist trainee) I= Minimal – Content I = None/NR F-38
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 Moriyama, 2009 Japan Muchmore, 1994 U.S. (CA) Murrock, 2009 U.S. (OH) I= 50 UC= 25 I 1= 12 I 2= 11 I= 36 UC= 34 22.2%, 91% 32.9±5.4kg/m 2 7.8±1.2%, NR I= 66.4±9.2y 40%, NR 60.0±11.0kg 7.5±1.5%, 7% UC= 65.2±8.5y 57%, NR 60.7±11.2kg 7.4±1.7%, 17% I 1= 57.3±2.3y 33%, NR 89.5±5kg 10.3±0.3%, 0% I 2= 60.1±2.2y 45%, NR 99±5kg 10.45±.04%, 0% I= 58.5±12.2y 0%, 100% 94.8±26.9kg 7.7±1.2%, 21% UC= 67.1±7.9y 0%, 100% D) with diet, PA and stress management training DSME; Cognitivebehavior theorybased program focused on diet, PA and family support I 1= Lifestyle; behavioral weight loss program plus basic DM diet education I 2= Lifestyle; behavioral weight loss program plus diet and blood glucose regulation intervention Lifestyle; dance and peer support for African American women sessions 12m; 12+24 telephone followups, 6h+telephone call duration; NA I 1= 6.5m; 23, 22+; 3.7m I 2= 6.5; 23, 22+; 3.7m 2.8m; 24, 24+social support activity duration; NA Mixed I 1= In-person I 2= In-person Individual (Plus family provided information) I 1= Mixed I 2= Mixed HCP (RN) I 1= Multidisciplinary (RN, RD) I 2= Multidisciplinary (RN, RD) In-person Group Non-HCP (African American dance instructor) & HCP (RN) Moderate-to- High – Content & Delivery I 1= Minimal – Content I 2= Moderateto-High - Content Moderate-to- High – Content & Delivery None/NR I 1= None/NR I 2= None/NR Yes F-39
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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
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led structured program on blood glu
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Engineering. 2014;75(1-B E). PMID:
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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
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
Page 297 and 298: References for Appendix I 1. Adachi
Page 299 and 300: 32. Rock CL, Flatt SW, Pakiz B, et
Page 301 and 302: 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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