Behavioral Programs for Diabetes Mellitus

Table 10. Type 1 diabetes: summary of key findings and strength of evidence for subgroups (by
age) receiving behavioral programs compared with active controls
Outcome # Trials (# Subjects) Mean Difference Strength of Evidence
Youth
HbA 1c (EOI) 3 (419) 87,92,108 MD, -0.33; 95% CI -1.65 to 0.99 Insufficient
HbA 1c (6m) 2 (208) 92,108 MD, -0.60; 95% CI -2.56 to 1.36 Insufficient
HbA 1c (12m) 2 (195) 92,108 MD, -0.52; 95% CI -1.04 to 0.00 Low for benefit
Adults
HbA 1c (EOI) 1 (110) 107 MD, -0.35; 95% CI -0.81 to 0.11 Insufficient
HbA 1c (6m) 2 (259) 91,107 MD, -0.38; 95% CI -0.93 to 0.17 Low for no difference
HbA 1c (12m) 1 (110) 107 MD, -0.14; 95% CI -1.04 to 0.16 Insufficient
CI = confidence interval; EOI = end of intervention; HbA 1c = hemoglobin A 1c ; m = month; MD = mean difference
KQ 3. Potential Moderation of Effectiveness for T1DM:
Components, Intensity, Delivery Personnel, Method of
Communication, Degree of Tailoring, and Level of Community
Engagement
To assess whether the effectiveness of behavioral programs differed based on various
program factors (i.e., intensity, delivery personnel, method of communication, degree of
tailoring, and level of community engagement), we performed univariate meta-regressions for
comparisons between behavioral programs and usual care at longest followup (Table 11). See
Table 3 in Methods for our classification scheme. See the Characteristics of Included Studies
section for a summary, and the description of interventions for each study in the summary tables
in Appendix F.
We did not have enough studies to conduct a multiple variable meta-regression analysis, nor
were there sufficient studies for analysis of those comparing behavioral programs with active
controls or other behavioral programs. We conducted the analysis for HbA 1c ; other outcomes did
not have sufficient studies (≥10 studies) associated with them to support meaningful analyses.
All but one study 105 fell under the category of DSME, therefore we did not conduct a regression
analysis on program components.
Key Points
• Program intensity, including duration, contact hours, and frequency of contacts, appeared
not to influence program effectiveness; the results were not statistically significant but
were very precise (i.e., narrow 95% CIs) for no incremental effect when increasing
intensity.
• Although not reaching statistical significance, delivery of programs to individuals
appeared beneficial compared with delivery to groups.
Detailed Synthesis
Table 11 summarizes the results of the univariate meta-regressions conduced with 25
studies. 82-86,88,89,93-96,98-106,108-112 Duration of intervention (months), intensity (contact hours) and
frequency of contacts were analyzed as continuous variables. Frequency of contacts is a
composite variable combining duration and contact hours (contact hours per month). The
delivery personnel variable had three categories. The remaining variables were dichotomized as
shown in Table 11. The analysis for support persons assessed the impact of programs targeted at
youth alone compared with those targeted at both youth and their parents or families; adult
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