Behavioral Programs for Diabetes Mellitus

Table 4. Other clinical and behavioral outcomes for type 1 diabetes (continued)
# Trials (#
Outcome Timepoint Subjects, Control
Study Effect a
Conclusion
Group)
Triglycerides (mmol/l) EOI 1 (61 adults,
UC) 105 MD, 0.00; 95% CI, -0.39 to 0.39 No difference
EOI
Depression
(Swedish Hospital
Anxiety and
Depression scale)
Depression
(Patient Health
Questionnaire-9)
Depression
(Center for
Epidemiologic Studies
6m followup
6m followup
1 (74 adults, SMD, -0.51; 95%CI, -0.97 to -
UC) 82 0.05
Improved with
behavioral
program
1 (235 adults, SMD, 0.20; 95% CI, -0.05 to 0.46 No difference
UC) 94
1 (149 adults,
AC) 91
SMD, -0.30; 95% CI, -0.63 to
0.02
No difference
Depression Scale)
AC = active control; BMI = body mass index; CI = confidence interval; EOI = end of intervention; m = month; MD = mean
difference; QOL = quality of life; SMD = standardized mean difference; UC = usual care
a Negative values of MDs or SMDs are favorable for change in body composition, change in dietary intake, severe hypoglycemia,
diabetic ketoacidosis, LDL cholesterol, systolic blood pressure, triglycerides, and depression.
Health-Related Quality of Life: Behavioral Programs Compared With Usual
Care
Studies reporting on HRQL assessed this using generic and diabetes-specific quality of life
measures. Generic HRQL was measured by a number of tools (e.g., World Health Organization
Well-Being Index, 130 Pediatric Quality of Life [PedsQL], 131 Wellbeing Questionnaire 132 ), as was
diabetes-specific HRQL (PedsQL diabetes module, 131 Pediatric Diabetes Quality of Life, Wellbeing
Enquiry for Diabetes 133 ). A group of studies reported on diabetes distress/stress (tools
included Problem Areas in Diabetes 134 and Diabetes Stress Questionnaire 84 ), for which we
analyzed separately from diabetes-specific HRQL. For all analyses we present the results as
SMD. Figure 13 presents our meta-analyses of trials, stratified by age (youth and adults), that
reported generic HRQL at end of intervention. Longer-term followup results were reported for
generic HRQL and are summarized in Table 5. The meta-analysis results in Figure 14 for
diabetes-specific HRQL at end of intervention were not stratified by age. Figures 15 and 16
present the meta-analyses for diabetes distress at end of intervention (stratified by age) and 6-
month followup, respectively.
At the end of intervention for youth and adults combined (Figure 13), our meta-analysis (7
trials [5 youth, 93,96-98,110 2 adult 82,95 ], 474 subjects) found no difference in generic HRQL between
individuals receiving a behavioral program and those receiving usual care (SMD, 0.10; 95% CI, -
0.18 to 0.38). The lack of difference remained for the subgroups of adults (2 trials, 137 subjects;
MD, 0.35; 95% CI -1.93 to 2.63) 82,95 and youth (5 trials, 337 subjects; MD, 0.01; 95% CI -0.33
to 0.35). 93,96-98,110
41