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 96.5±20.8kg 7.4±0.1%, 21% Nishita, 2013 U.S. (HI) Palmas, 2014 U.S. (NY) Philis- Tsimikas, 2011 U.S. (CA) I= 128 UC= 62 I= 181 Att. C= 179 I= 104 UC= 103 I= 47.6±.09y 34.4%, 68.7% 32.4±0.7kg/m 2 7.8±0.2%, NR UC= 50.±1.2y 43.6%, 74.2% 34.2±1.1kg/m 2 7.7±0.2%, NR I= 57.1±7.7y 39.2%, 100% NR 8.8±1.7%, NR Att. C= 58.1±7.8y 37.4%, 100% NR 8.5±1.6%, NR I= 49.2±11.8y 25.2%, 98.1% 32.1±5.9kg/m 2 10.3±1.7%, NR UC= 52.2±9.6y 33.7%, 94.2% DSME; life coaching and pharmacist counseling using empowerment approach for employed adults I= DSME + Support; CHW-led intervention focused on problem solving and negotiating healthcare Att. C= mailed information and 4 telephone contacts I= DSME + Support; Project Dulce, peer-led diabetes education program for highrisk Mexican 12m; 14.0, 13h; NA (Plus nutritional counseling as appropriate) I= 12m; 13, 4.6h; 9m Att. C= 12m; 4+4 mail-outs, 0.7h; NA In-person Individual Non-HCP (graduates of social sciences degrees) & HCP (Pharmacist) I= Mixed Att. C= Technology 10m; 12, 16h; 8m In-person (Plus telephone reminders) I= Mixed Att. C= Individual Group I= Non-HCP (CHW) Att. C= Non-HCP (research assistant) Non-HCP (Promotores) Moderate-to- High – Content & Delivery I= Moderateto-High – Content & Delivery Att. C= None Moderate-to- High – Content & Delivery Yes I= Yes Att. C= None Yes F-40
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 Plotnikoff, 2011 Canada I 1= 49 I 2= 47 30.9±6.3kg/m 2 10.5±1.7%, NR I 1= 60 (25-75)y 40%, NR 34.3±5.7kg/m 2 7.8±2.2%, NR I 2= 60 (25-75)y 40%, NR 34.8±9.0kg/m 2 7.3±1.3%, NR Americans I 1= DSME + Support; I 2= DSME + Support; addition of individualized PA counseling with continual telephone support I 1= 12m; 11, 16.5h+; 11m I 2= 12m; 32, 17.5h+time for telephone counseling; 10m I 1= In-person I 2= Mixed I 1= Group I 2= Mixed I 1= HCP (CDE) I 2= Non-HCP (certified personal trainers) & HCP (CDE) I 1= Minimal – Content I 2= Moderateto-High – Content & Delivery I 1= None/NR I 2= Yes Prezio, 2013 U.S. (TX) Reaney, 2013 Germany & Spain (33 sites) I= 90 UC= 90 I= 330 UC= 351 (Mean, Range) I= 47.9±11.0y 33.3%, 77.8% 32.7±7.8kg/m 2 8.9±2.2%, NR UC= 45.7±10.7y 45.6%, 70% 33.9±8.2kg/m 2 8.7±2.3%, NR I= 62±9.6y 54.2%, NR 31.2±5.4 7.2 (6.5-8.0)%, 47% DSME + Support; Community Diabetes Education (CoDE) for uninsured Mexican Americans I= DSME; group DSME using Conversation Maps tools EU version 12m; 7, 7h; 10m In-person Individual Non-HCP (CHW) Moderate-to- High – Content & Delivery 1.5m; 4, 8-12h; NA In-person Group HCP (trained diabetes educator as per usual care at sites) Minimal - Content Yes None/NR UC= 61.9±8.7y 52.4%, NR 31.7±5.9kg/m 2 7.0 (6.4-7.8)%, F-41
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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
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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 253: 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
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
Page 303 and 304: 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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