Group-based training for self-management strategies in people with type 2 diabetes results

Deakin TA, McShane CE, Cade JE, Williams R

Published Online:

January 21, 2009

Adults with type 2 diabetes who have participated in group-based training programmes show improved diabetes control (fasting blood glucose and glycated haemoglobin) and knowledge of diabetes in the short (four to six months) and longer-term (12 to 14 months) whilst also having a reduced need for diabetes medication. There is also some evidence that group-based education programmes may reduce blood pressure and body weight, and increase self-empowerment, quality of life, self-management skills and treatment satisfaction. However, as only a small number of studies evaluated those outcomes, more research is required to confirm those findings.

Abstract (click to read)

Background:

It has been recognised that adoption of self-management skills by the person with diabetes is necessary in order to manage their diabetes. However, the most effective method for delivering education and teaching self-management skills is unclear.

Objectives:

To assess the effects of group-based, patient-centred training on clinical, lifestyle and psychosocial outcomes in people with type 2 diabetes.

Search strategy:

Studies were obtained from computerised searches of multiple electronic bibliographic databases, supplemented by hand searches of reference lists of articles, conference proceedings and consultation with experts in the field.

Selection criteria:

Randomised controlled and controlled clinical trials which evaluated group-based education programmes for adults with type 2 diabetes compared with routine treatment, waiting list control or no intervention. Studies were only included if the length of follow-up was six months or more and the intervention was at least one session with the minimum of six participants.

Data collection and analysis:

Two reviewers independently extracted data and assessed study quality. A meta-analysis was performed if there were enough homogeneous studies reporting an outcome at either four to six months, 12-14 months, or two years, otherwise the studies were summarised in a descriptive manner.

Main results:

Fourteen publications describing 11 studies were included involving 1532 participants. The results of the meta-analyses in favour of group-based diabetes education programmes were reduced glycated haemoglobin at four to six months (1.4%; 95% confidence interval (CI) 0.8 to 1.9; P < 0.00001), at 12-14 months (0.8%; 95% CI 0.7 to 1.0; P < 0.00001) and two years (1.0%; 95% CI 0.5 to 1.4; P < 0.00001); reduced fasting blood glucose levels at 12 months (1.2 mmol/L; 95% CI 0.7 to 1.6; P < 0.00001); reduced body weight at 12-14 months (1.6 Kg; 95% CI 0.3 to 3.0; P = 0.02); improved diabetes knowledge at 12-14 months (SMD 1.0; 95% CI 0.7 to 1.2; P < 0.00001) and reduced systolic blood pressure at four to six months (5 mmHg: 95% CI 1 to 10; P = 0.01). There was also a reduced need for diabetes medication (odds ratio 11.8, 95% CI 5.2 to 26.9; P < 0.00001; RD = 0.2; NNT = 5). Therefore, for every five patients attending a group-based education programme we could expect one patient to reduce diabetes medication.

Authors' conclusions:

Group-based training for self-management strategies in people with type 2 diabetes is effective by improving fasting blood glucose levels, glycated haemoglobin and diabetes knowledge and reducing systolic blood pressure levels, body weight and the requirement for diabetes medication.

This record should be cited as:

Deakin TA, McShane CE, Cade JE, Williams R. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD003417. DOI: 10.1002/14651858.CD003417.pub2

Assessed as up to date:

February 28, 2003

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Primary Review Group:

Metabolic and Endocrine Disorders Group

Health topics:

Endocrine & metabolic > Diabetes > Type 2

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Group-based training for self-management strategies in people with type 2 diabetes results

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