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 Rosal, 2011 U.S. (MA) Rosal, 2014 U.S. (MA) Rothschild, 2014 U.S. (IL) I= 124 UC= 128 I 1 = 43 I 2 = 46 I= 73 Att. C= 71 I= 18 - >65y 21.8%, 100% 34.5±6.5kg/m 2 8.9±1.8%, 42.8% UC= 18 - >65y 25%, 100% 34.5±6.5kg/m 2 9.1±2.0%, 54.7% I 1= 52±11y 0%, 100% 34.4±8.0kg/m 2 9.4±2%, 53.5% I 2= 53±10y 0%, 100% 36.4±8kg/m 2 9.6±2%, 45.7 I= 53.7±11.7y 35.6%, 100% 32.7±7.4kg/m 2 8.5±2.2%, 19.2% Att. C= 53.6±12.7y 29.6%%, 100% 34.2±9.5kg/m 2 8.1±1.6%, 12.7% DSME + Support; Latinos en Control, community-based, culturally tailored self-management intervention for low-income, Spanish-speaking Latinos I 1 = DSME; Adaptation of Power to Prevent I 2 = DSME; Virtual adaptation of Power to Prevent I= DSME + Support; Mexican Americans Trial of Community Health Workers (MATCH) providing in-home self-management training Att. C; 36 mailed bilingual diabetes self-management 12m; 21, 51h; 8m (Plus telephone reminders) I 1 = 2m; 8, 12h; NA I 2 = 2m; 8, 12h; NA I= 24m; 36, 54h; 12m Att. C = 24m; 36, Oh; NA In-person I 1 = Inperson I 2 = Technology I= In-person Att. C= mail only Mixed with supports I 1 = Group I 2 = Group I= Individual Att. C= NA Non-HCP (trained lay person) & HCP (RD, health educator) I 1 = Multidisciplinary (RD [CDE], NP) I 2 = Multidisciplinary (RD [CDE], NP) I= Non-HCP (CHW) Att. C= NA Moderate-to- High – Content & Delivery I 1 = Moderateto-high - Content, I 2 = Moderateto-high – Content and Delivery I= Moderateto-High – Content & Delivery Att. C= Minimal - Content Yes I 1 = None/NR I 2 = None/NR I= Yes Att. C= None/NR F-44
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 Ruggerio, 2010 U.S. (IL) Ruggerio, 2014 U.S. (IL) Sacco, 2009 U.S. (FL) Salinero-Fort, 2011 Spain I= 25 UC= 25 I= 136 UC= 134 I= 31 UC= 31 I 1= 304 I 2= 304 All participants= 65.8±9.4y 34%, 100% 32.4±6.6kg/m 2 HbA1c: I= 8.5±1.7% UC= 8.9±1.6% Insulin use NR I= 53.2±11.7y 32.1%, 100% 33.0±6.4kg/m 2 8.7±2.4%, NR UC= 53.1±13.0y 30.3%, 100% 33.4±6.4kg/m 2 8.5±2.3%, NR All participants = 52±8.6y 42%, 22.6% 35.8±7.7kg/m 2 8.5±1.7%, 53% I 1= 67.3±19y 51%, NR 30.5±5.2kg/m 2 newsletters DSME; Medical assistant self-care coaching intervention using empowerment approach for lowincome racial/ethnic minorities DSME; Medical assistant self-care coaching intervention using empowerment approach for lowincome racial/ethnic minorities DSME; brief CBTbased coaching telephone intervention delivered by paraprofessional for T2DM ≥1 cardiovascular risk factors I 1= DSME; Conventional Health Promotion 6m; 6, 2h; NA (Plus telephone reminders) Mixed Individual Non-HCP (certified medical assistants) 12m; 12, 4h; NA Mixed Individual Non-HCP (certified medical assistants) 6m; 16, 6h; NA Mixed (1 inperson session) I 1= 24m; 10, 6.7h; NA I 1= In-person I 2= In-person Individual I 1= Individual I 2= Individual Non-HCP (undergraduate psychology students) I 1= HCP (RN) I 2= HCP (RN) Moderate-to- High – Content & Delivery Moderate-to- High – Content & Delivery Minimal – Content & Delivery I 1= Minimal – Content & Delivery Yes Yes None/NR I 1= None/NR F-45
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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
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Americans with type 2 diabetes. J A
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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 257: 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
Page 305 and 306: Appendix J. Network Meta-Analysis R
Page 307 and 308: 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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