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Alliston P, Jovkovic M, Khalid S, Fitzpatrick-Lewis D, Ali MU, Sherifali D. The effects of diabetes self-management programs on clinical and patient reported outcomes in older adults: a systematic review and meta-analysis. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1348104. [PMID: 38952998 PMCID: PMC11215190 DOI: 10.3389/fcdhc.2024.1348104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/31/2024] [Indexed: 07/03/2024]
Abstract
Objectives With diabetes self-management continuing to become more complex for older adults, self-management programs have been shown to support this population in meeting their multifaceted medical needs. Building on our previous systematic review and meta-analysis, we aimed to update the literature on the effectiveness of diabetes self-management programs and investigate the impact of specific self-management interventions on clinical and patient-reported outcomes. Methods We updated our literature search in the following databases: Medline, EMBASE, PsychINFO, CINAHL and Cochrane Database of Randomized Controlled Trials from November 2013 to July 2023 for studies that may fit our inclusion criteria. Two independent reviewers screened and extracted data from the included group of studies. Results A total of 17 studies with 21 comparison arms met the inclusion criteria, totalling 5976 older adults (3510 individuals randomized to self-management programming and 2466 to usual care). The pooled effectiveness of diabetes self-management programs in older adults on glycemic control (hemoglobin A1C) was a reduction of -0.32 (95% CI -0.44, -0.19). Specifically, the most effective approach on glycemic control (A1C) was the use of feedback (-0.52%; 95% CI -0.68, -0.36). Overall, self-management programs improved behaviour change outcomes, with feedback interventions being most effective (standardized mean difference [SMD] 0.91; 95% CI 0.39, 1.43). The effect of self-management programs on body mass index, weight and lipids were statistically and clinically significant. Conclusions The evidence for diabetes self-management programs for older adults demonstrates a small but clinically meaningful reduction in A1C, improvement in patient-reported outcomes (behaviour, self-efficacy, knowledge), and other clinical outcomes (BMI, weight and lipids). The specific strategy used in diabetes self-management programs for older adults should be considered to achieve optimal results on outcomes.
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Affiliation(s)
- Paige Alliston
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Milos Jovkovic
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Saira Khalid
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Muhammad Usman Ali
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Diana Sherifali
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
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Nsobundu C, Nmadu YW, Wagle NS, Foster MJ, McKyer ELJ, Sherman L, Ory MG, Burdine JJN. Process Evaluations of Diabetes Self-Management Programs: A Systematic Review of the Literature. Am J Health Promot 2024:8901171241238554. [PMID: 38648265 DOI: 10.1177/08901171241238554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To conduct a systematic review of process evaluations (PEs) of diabetes self-management programs (DSMPs). DATA SOURCE An electronic search using Medline (Ovid), Embase (Ovid), CINAHL (Ensco), Academic Search (Ebsco), and APA PsycInfo (Ebsco). STUDY INCLUSION AND EXCLUSION CRITERIA Peer-reviewed, empirical quantitative, qualitative, or mixed-method studies were included if they (1) were a traditional, group-based DSMP, (2) involved adults at least 18 years with T1DM or T2DM, (3) were a stand-alone or embedded PE, and (4) published in English. DATA EXTRACTION The following process evaluation outcomes were extracted: fidelity, dose delivered, dose received, reach, recruitment, retention, and context. Additional items were extracted, (eg, process evaluation type, data collection methods; theories; frameworks or conceptual models used to guide the process evaluation, and etc). DATA SYNTHESIS Due to heterogeneity across studies, studies were synthesized qualitatively (narratively). RESULTS Sixty-eight studies (k) in 78 articles (n) (k = 68; n = 78) were included. Most were mixed methods of low quality. Studies were typically integrated into outcome evaluations vs being stand-alone, lacked theoretical approaches to guide them, and incorporated limited outcomes such as dose received, reach, and retention. CONCLUSION Future research should 1) implement stand-alone theoretically grounded PE studies and 2) provide a shared understanding of standardized guidelines to conduct PEs. This will allow public health practitioners and researchers to assess and compare the quality of different programs to be implemented.
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Affiliation(s)
- Chinelo Nsobundu
- Center for Community Health & Aging, School of Public Health, Texas A&M University, College Station, TX, USA
- School of Medicine, St George's University, St George's, Grenada
| | - Yeka W Nmadu
- Department of Pediatrics, University of Florida College of Medicine- Jacksonville, Jacksonville, FL, USA
| | - Nikita Sandeep Wagle
- Population Informatics Lab, Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Margaret J Foster
- Department of Medical Education, Texas A&M College of Medicine, College Station, TX, USA
| | - Ellisa Lisako Jones McKyer
- Vice Dean Faculty Affairs & Diversity, Equity, and Inclusion, Alice L. Walton School of Medicine, Bentonville, AR, USA
| | - Ledric Sherman
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Marcia G Ory
- Department of Environmental & Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
| | - James Jim N Burdine
- Department of Health Behavior, Director of the Center for Community Health & Aging, School of Public Health, Texas A&M University, College Station, TX, USA
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Nagpal J, Rawat S, Gupta L, Negi A, Oraon DS. A stepped wedge cluster randomized trial to evaluate the effectiveness of a community leader-driven kit-based diabetes self-management education approach in improving diabetes control and care: study protocol for the DElhi Diabetes INTervention Trial (DEDINTT). Trials 2023; 24:673. [PMID: 37845694 PMCID: PMC10580654 DOI: 10.1186/s13063-023-07712-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Diabetes self-management education (DSME) helps patients self-manage their condition and improve outcomes/quality of life. However, access to DSME is limited, particularly in low-income areas. This study aims to develop a DSME training kit (EK-DIN), understand barriers to implementation, and evaluate the effectiveness and sustainability of community leader (CL)-based rollout using a stepped wedge cluster randomized trial format. METHODS AND ANALYSIS The mixed methods study will begin with a qualitative study to evaluate the facilitators and barriers towards CL-based DSME. The in-depth interview notes will be transcribed for thematic analysis. These results will be utilized for a stakeholder's workshop to develop the EK-DIN kit, a patient-interfacing app, and an implementation plan. Rollout will be conducted in 30 clusters in Delhi, preselected by the DEDICOM-II survey in 5 steps (6 clusters every 3 months: 2 each from each socio-economic category; randomly selected per sequence). A CL from each cluster will be trained in using the EK-DIN kit/app over 1 month. The trained CL will conduct DSME sessions among the cluster residents using the EK-DIN kits provided fortnightly for 3 months. Compliance and blood parameters data will be collected at baseline, 3 months after the intervention, and every quarter thereafter till completion. Change in HbA1c before and after the intervention will be evaluated as the primary outcome using the swCRTdesign package for R version 4.0.2 and the swSummary function. The sustainability of the effects will be evaluated using the change in quarterly parameters after intervention completion. DISCUSSION A positive result will set the template for a generalizable public health intervention with proven community effectiveness, sustainability, cost-effectiveness, and positive quality-of-life impact. While a negative result will require the testing of alternative approaches, it would still add substantially to existing knowledge on the subject. Given the diverse socio-cultural setting in which the trial is being proposed and the high power of the study, the results (positive or negative) should be widely applicable and have policy implications. TRIAL REGISTRATION CTRI/2023/07/054963. Date of Registration: 7th July 2023.
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Affiliation(s)
- Jitender Nagpal
- Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110016, India.
| | - Swapnil Rawat
- Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110016, India
| | - Lovely Gupta
- Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110016, India
| | - Avantika Negi
- Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110016, India
| | - Divya Shashi Oraon
- Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110016, India
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Izquierdo V, Pazos-Couselo M, González-Rodríguez M, Rodríguez-González R. Educational programs in type 2 diabetes designed for community-dwelling older adults: A systematic review. Geriatr Nurs 2022; 46:157-165. [PMID: 35700683 DOI: 10.1016/j.gerinurse.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 12/14/2022]
Abstract
AIMS This systematic review aimed to assess the effectiveness of educational interventions in type 2 diabetes specifically designed for community-dwelling older adults. METHODS In accordance with PRISMA guidelines, a systematic search of studies published between 2010 and 2021 was conducted across five electronic databases and manual sources. The study protocol was previously registered in PROSPERO (CRD42021288236). RESULTS Twelve papers matched the inclusion criteria and were appraised using MERSQI. The features of the educational programs were heterogeneous, and none complied with the ten suggested standards for diabetes self-management education and support. Comprehensive gerontological assessment was not considered. Outcomes included biomedical, psychosocial, behavioral, and knowledge measures. HbA1c and knowledge showed improvements with a high certainty level according to GRADE. CONCLUSIONS Structured DSME programs aimed at older adults have great potential, however there is still room to improve. Applying the principles of a comprehensive gerontological approach and the standards for DSME as continuous monitoring and support could increase their benefits.
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Affiliation(s)
- Veronica Izquierdo
- Faculty of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marcos Pazos-Couselo
- Faculty of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain; Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; Research Methods (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | | | - Raquel Rodríguez-González
- Faculty of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain; Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Chen MC, Palmer MH, Lin SY. Pilot test of a learned resourcefulness program for older family caregivers in Taiwan. Geriatr Nurs 2021; 42:1129-1134. [PMID: 34314942 DOI: 10.1016/j.gerinurse.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
Learned resourcefulness, a theory-based education intervention, can be applied to provide strategies to improve the health status and reduce caregiver burden for older family caregivers. We developed a culturally relevant SOURCE program and designed a pilot study to its effect and feasibility for older family caregivers living in Taiwan. Using a quasi-experimental study with one-group, pre-test and post-test design, we recruited a convenience sample of 30 older family caregivers who received home-care services from a regional hospital in southern Taiwan. The older family caregivers participated in and completed the four-week SOURCE program. Effectiveness and feasibility data were collected after the completion of the program. Results indicated that the SOURCE program significantly improved caregiving burden (t = 3.05, p = .005) and revealed that the program was helpful and useful to older family caregivers. The next step will be to use the SOURCE program with more older family caregivers.
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Affiliation(s)
- Meng-Chun Chen
- Department of Nursing, I-Shou University, Kaohsiung; 8 Yida Rd., Jiaosu Village Yanchao District, Kaohsiung City, 82445 Taiwan; Department of Nursing, Chang Gung Memorial Hospital, Chiayi; 6 Chia-Pu Rd., West Section, Putz City, Chiayi County, Taiwan 61363
| | - Mary H Palmer
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, CB 7460, Chapel Hill, NC 27599, USA
| | - Shu-Yuan Lin
- School of Nursing, Kaohsiung Medical University; 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung, 80708 Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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