Behavioral Programs for Diabetes Mellitus

HbA 1c : Comparative Effectiveness of Two Behavioral Programs
One RCT (72 youth) examined the same DSME program delivered in person compared with
delivery by Skype. 90 There was no difference in HbA 1c between groups at the end of intervention
(MD, -0.04; 95% CI, -0.87 to 0.79) or at 6-month followup (MD, -0.24; 95% CI, -1.10 to 0.62).
Adherence to Diabetes Self-Management: Behavioral Programs Compared
With Usual Care
This section presents the results from trials that reported on adherence to diabetes selfmanagement.
This outcome was measured in a number of ways and we report them separately.
The most common measure was self-monitoring of blood glucose (SMBG) and was most
commonly reported as the frequency of blood glucose testing over 1 day. 84,86,88,96,104 Two studies
reported the frequency of testing over the past week; 93,109 we converted this to the number of
tests per day. We present separate forest plots for different timepoints (end of intervention, 6
month followup). We provide a narrative summary of the one RCT that reported outcomes for
longer followup.
At the end of intervention (Figure 11), our meta-analysis (4 trials, 282 youth) found no
difference in frequency of SMBG between youth receiving a behavioral program and those
receiving usual care (MD, 0.15; 95% CI, -0.54 to 0.84). 84,88,93,96
Figure 11. Behavioral programs for type 1 diabetes compared with usual care: self-monitoring of
blood glucose (tests per day) at end of intervention
CI = confidence interval; n = number of participants; SD = standard deviation
At the end of 6-month postintervention for youth and adults combined (Figure 12), our metaanalysis
(5 trials [4 youth, 84,86,88,93 1 adult 109 ], 252 subjects) found no difference in SMBG
between individuals receiving a behavioral program and those receiving usual care (MD, 0.40;
95% CI, -0.36 to 1.16). Adults receiving the behavioral program in the trial of Zoffmann et al. 109
increased their frequency of SMBG (MD, 1.42; 95% CI, 0.11 to 2.75).
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