Behavioral Programs for Diabetes Mellitus

Health-Related Quality of Life: Behavioral Programs Compared With Active
Control
One trial in youth failed to demonstrate a difference in diabetes-related quality of life
between a behavioral program and an active control at 12-month followup (130 subjects;
insufficient data reported to calculate SMD). 92
Diabetes-Related Health Care Utilization: Behavioral Programs Compared
With Usual Care
Diabetes-related health care utilization was reported infrequently and only for trials
comparing behavioral programs to usual care. We summarize the results in Table 6. One RCT in
youth found a reduced risk of diabetes-related hospital admissions at end of intervention and at
6-month followup for those receiving behavioral programs compared with usual care. 88 The
same trial also reported fewer admissions to the emergency department at the end of
intervention. Another RCT in youth 85 and one in adults 94 found no difference in hospital
admission at any timepoint. One trial reported that there was no difference in the number of
diabetes-related hospital and emergency department admissions at the 6-month followup;
however, the authors did not provide any data. 97
Table 6. Behavioral programs for type 1 diabetes compared with usual care: diabetes-related
health care utilization at end of intervention, 6-, 12-, and 24-month postintervention followup
# Trials
Outcome Timepoint
Study Effect
Conclusion
(#Subjects)
Hospitalizations EOI 1 (95 youth) 88 RR, 0.28; 95% CI, 0.15 to 0.55 Lower risk of admissions
(# admissions)
for behavioral program
Hospitalizations 6m followup 1 (98 youth) 88 RR, 0.41; 95% CI, 0.21 to 0.78 Lower risk of admissions
(# admissions)
for behavioral program
Hospitalizations 24m followup 1 (343 youth) 85 RR, 0.78; 95% CI, 0.45 to 1.34 No difference
(# admissions)
Hospitalizations EOI 1 (159 adults) 94 RR, 1.88; 95% CI, 0.49 to 7.25 No difference
(# admissions)
Hospitalizations 6m followup 1 (198 adults) 94 No difference
RR, 0.90; 95% CI, 0.35 to 2.32
(# admissions)
Emergency Dept EOI 1 (98 youth) 88 MD, -0.21; 95% CI, -0.34 to - Fewer admissions for
(# admissions)
0.08
behavioral program
CI = confidence interval; EOI = end of intervention; m = month; MD = mean difference; RR = risk ratio
Program Acceptability: Behavioral Programs Compared With Usual Care
Figure 17 presents our meta-analysis stratified by age (youth and adults) of trials that
reported participant attrition at their longest followup timepoint. Our meta-analysis (21 trials,
2,503 subjects) found a 21 percent increased risk of attrition for individuals receiving usual care
compared with those receiving the behavioral program (RR, 1.21; 95% CI, 1.05 to 1.39). 82-
86,88,89,93-95,99,100,102-106,108-111
45