Behavioral Programs for Diabetes Mellitus

• The effectiveness of behavioral programs compared with active controls appeared higher
for youth than for adults at12-month followup; the effectiveness for youth was clinically
important. The small number of studies in most subgroups provided insufficient SOE.
• One trial reported results separately for youth with baseline HbA 1c ≥8 percent and found
favorable results for this subgroup.
• No trials reported on HbA 1c by race or ethnicity, socioeconomic status, or time since
diagnosis.
Detailed Synthesis
Age
In KQ 1, we presented our results by age groups (youth and adults). Behavioral programs
appeared to be more effective in reducing HbA 1c for adults than for youth at end of intervention
when compared to usual care (Figure 5); the effect size in the meta-analysis for adults 82,94,95,105,112
was greater in absolute terms than for the youth 83,84,89,93,96,98,99,101,106,108,110 (MD = -0.28 vs. 0.00
respectively); the results for adults approached statistical significance and the 95% CI contained
our threshold for clinical importance. At 6-month followup, the effect sizes for
youth 84,86,88,93,100,102-104,108,111 and adults 94,109 appeared similar (MD = -0.28 vs. MD = -0.38,
respectively); only the results for youth reached statistical significance, although the 95% CIs in
both groups included a clinically important effect size favoring behavioral programs. No study in
adults reported at 12-month followup; the youth results showed no difference (MD, -0.22; 95%
CI, -0.49 to 0.05) although the 95% CI included a clinically important effect for behavioral
programs.
When compared with active controls at end of intervention, the effect sizes for youth (MD, -
0.33; 95% CI -1.65 to 0.99) and adults (MD, -0.35; 95% CI -0.81 to 0.11) were both similar to
the overall effect size and nonsignificant with imprecise 95% CIs. At 6-month followup, the
effect size was larger for the youth 92,108 than for the adults 91,107 (MD -0.60 vs. -0.38) but both
results failed to reach statistical significance. At 12-month followup, results for youth were
statistically significant and clinically important (MD, -0.52; 95% CI, -1.04 to 0.00); 92,108 for
adults there was no difference at 12-month followup (MD, -0.14; 95% CI, -1.28 to 1.00). 107 .
In the studies that included adults only, the mean age across the studies ranged from 30.3–
49.2 years. None of the studies reported results separately for young adults or older adults.
Level of Glycemic Control
One RCT (101 youth) conducted a subgroup analysis of 54 youth with suboptimal baseline
glycemic control (HbA 1c ≥8 percent). 96 At the end of intervention, Katz et al. 96 found that those
receiving the behavioral program had greater odds of maintaining or improving their HbA 1c
compared with those receiving usual care (odds ratio, 3.4; 95% CI, 1.0 to 11.9). This compares
favorably to the overall study results which found no difference in change in glycemic control
for the group receiving the behavioral program (MD, 0.30; 95% CI, -0.22 to 0.82). No data were
reported for the subgroup of youth with optimal baseline HbA 1c . Subgroup analysis at the study
level was not conducted because the mean baseline HbA 1c was >7 percent for all studies.
Other Subgroups
No data were reported for any of our other pre-specified subgroups: race or ethnicity,
socioeconomic status, or time since diagnosis.
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