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 Steed, 2005 United Kingdom Sung, 2012 Korea Tang, 2014 U.S. (MI) I= 65 UC= 59 I= 22 UC= 18 I 1= 56 I 2= 60 I= 59.2±8.8y 67.7%, 47.7% NR 8.2±1.3%, NR UC= 60.3±8.6y 74.6%, 56.2% NR 8.6±1.8%, NR I= 70.2±4.7y 31.8%, NR 23.9kg/m 2 7.6±1.1%, 31.8% UC= 70.1±3.6y 38.9%, NR 25.5kg/m 2 7.6±1.4%, 44.4% I 1= 48.4±10.0y 35.7%, 100% 32.0±4.6kg/m 2 7.8±1.7%, 25% I 2= 50.2±11.2y 46.7%, 100% 33.0+/-7.6kg/m 2 8.2±2.2%, 20% DSME; University College London diabetes selfmanagement programme (UCL- DSMP) Lifestyle; Supervised walking program with basic education for the elderly I 1= DSME + Support; CHW-led Partners in Care & DSMS led by CHWs for Latinos I 2= DSME + Support; CHW-led Partners in Care & DSMS led by peer leaders for Latinos 3m; 6, 15h; NA In-person Group HCP (DSN) Minimal - Content 6m; 34, 24h; NA In-person Mixed NR Moderate-to- High – Content I 1= 18m; 16.9, 25.5h; 12m I 2= 18m; 17.7, 26h; 12m (Per protocol had many more contacts in DSMS phase) I 1= Mixed I 2= Mixed I 1= Mixed with supports I 2= Mixed with supports I 1= Non-HCP (CHW) I 2= Non-HCP (CHW & peers) I 1= Moderateto-High – Content & Delivery I 2= Moderateto-High – Content & Delivery None/NR None/NR I 1= Yes I 2= Yes F-52
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 Thoolen, 2007 The Netherlands I= 89 UC= 108 I= 62.0±4.9y 64%, NR NR NR, NR UC= 61.9±5.6y 55%, NR NR NR, NR DSME; Beyond Good Intentions, focused on coping and self-regulation around diet, exercise and medications 3m; 6, 10h; NA In-person Mixed HCP (RN) Minimal – Content & Delivery None/NR Toobert, 2003 U.S. (OR) I= 163 UC= 116 Toobert, 2011 I= 142 UC= 138 I= 61.6±8.0y 0%, 8% 35.1±7.75kg/m 2 7.4±1.3%, 20.4% UC= 60.7±7.8y 0%, 5.3% 35.6±8.85kg/m 2 7.4±1.5%, 21.6% I= 55.6±9.7y 0%, 100% 35.3±7.05kg/m 2 8.4±1.9%, 29.1% Lifestyle; Mediterranean Lifestyle Program (multicomponent program focusing on reduction of behavioral CHD risk factors of diet, PA, social support, stress management and smoking cessation) Lifestyle; Viva Bien (adaptation of Mediterranean Lifestyle Program for Latinos) 6m; 29, 124h; NA In-person (telephone followup for missed sessions) 24m; 52, 208h; 18m In-person Group Non-HCP (>75%; lay leaders & RAs) & Multidisciplinary (RD, Exercise physiologist) Group with supports during maintenance phase Non-HCP (>75% trained bilingual facilitators) & Multidisciplinary (RD, Physician) Minimal – Content & Delivery Moderate-to- High – Content & Delivery Yes Yes UC= 58.7±10.3y 0%, 100% 33.2±6.75kg/m 2 F-53
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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.
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Table E1. Risk of bias for studies
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Weinger, 2011 L M NA M NA L NA L L
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Cramer, 2007 M M H M H L H H L M H
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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
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
Page 309 and 310: 9 11-26h In person Group only NA -0
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Behavioral Programs for Diabetes Mellitus

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