Does nutritional education improve the risk factors for cardiovascular diseases among elderly patients with type 2 diabetes? A randomized controlled trial based on an educational model

The effects of diabetes self-management programs on clinical and patient reported outcomes in older adults: a systematic review and meta-analysis

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.

Effectiveness of a Cluster Randomized Controlled Trial Involving Community-Based Intervention for Older Adults With Type 2 Diabetes Mellitus in Singapore

Purpose:

The purpose of the study was to investigate the effectiveness of a community-based intervention on improving knowledge about diabetes, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus (T2DM) in Singapore, a country in Asia with a high prevalence of diabetes.

Methods:

A 3-arm cluster randomized controlled trial involving community-dwelling older adults ages 55 to 99 with T2DM was conducted. Intervention group 1 and 2 participants received a 12-session intervention program designed to teach knowledge and practical skills in diabetes self-care with psychological techniques for behavioral change like problem solving, goal setting, and motivational interviewing. In addition, intervention group 2 participants received a glucometer and a supply of accessories each. The control group received routine care from their health care providers.

Results:

Compared to the control group, intervention group 2 reported an increase in medication adherence and self-monitoring of blood glucose (SMBG) at 3-month follow-up and increased knowledge about diabetes and self-care behavior in general diet control at 6-month follow-up.

Conclusions:

The community-based intervention should be extended to more older adults with T2DM in the community. Glucometers and accessories could be provided at subsidized rates or be made free contingent on older adults’ income status to overcome the barrier of performing SMBG.

Efficacy of community-based self-care interventions to improve biophysical, psychosocial or behavioural outcomes among community-dwelling older adults with type 2 diabetes: A systematic review and meta-analysis

AIMS

This review assessed the efficacy of self-care interventions to improve biophysical, psychosocial or behavioural outcomes among older adults with diabetes.

METHODS

Computerised and manual searches were performed. A total of 18 randomised control trials were included in the review, of which eight were subsequently included in the meta-analysis.

RESULTS

Most studies were from the United States of America and adopted a collaborative approach with participants. The specific needs of older adults were often not considered, and there was a predominance of biophysical measures. Meta-analysis revealed that among intervention condition participants, there were improvements in HbA1c (pooled weighted mean difference (WMD) -0.33, 95%CI -0.48 to -0.17), systolic blood pressure (WMD -1.55, 95%CI -2.93 to -0.18), diastolic blood pressure (WMD -1.41 95%CI -2.08 to -0.20), triglyceride (WMD -13.25, 95%CI -23.31 to -3.20), high-density lipoprotein (WMD 2.05, 95%CI 1.04 to 3.06) and Diabetes Self-Care Activities score (mean 4.10, 95%CI 3.11 to 5.10) compared to the control group. There was no significant change for low-density lipoprotein (WMD -5.93, 95%CI -12.08 to 0.22).

CONCLUSIONS

While continuing to adopt a collaborative approach, future self-care interventions should incorporate psychosocial and behavioural outcomes, consider the specific needs of older adults, and focus on more ethnically diverse populations.

Determinants of glycemic control: Phase 2 analysis from nationwide diabetes report of National Program for Prevention and Control of Diabetes (NPPCD-2018)

BACKGROUND

Diabetes is one of the leading causes of morbidity and mortality worldwide, especially among middle and low income nations. Many diabetic complications and comorbidities are attributable to poor glycemic control. The aim of this study was to update and extend the national diabetes reports on the status of comorbidities, diabetes care and complications in Iran. Moreover, we investigated the risk factors of poor glycemic control in the Iranian population.

METHODS

National database of 99,651 patients with diabetes who attended university-affiliated clinics between April 1, 2017 and February 30, 2018 was used to carry out a cross-sectional study. Stepwise backward selection logistic regression model was used to examine the associated factors of glycemic control.

RESULTS

In this study 73.0% and 56.5% of the enrolled population with diabetes, had hypertension and hyperlipidemia, respectively. The prevalence of patients who received education for nutrition therapy or diabetes self-management was 16.3% and 23.3% respectively. Poor glycemic control was associated with male gender (OR=1.06, p=0.001), obesity (OR=1.03, p=0.05), duration of diabetes (OR=1.018, p<0.001), smoking (OR=1.08, p=0.041), hypertension (OR=1.53, p<0.001), hyperlipidemia (OR=1.15, p<0.001), insulin therapy (OR=1.26, p<0.001) and combination of insulin and oral anti-diabetic agents compared to oral anti-diabetic agents alone (OR=2.36, p<0.001).

CONCLUSION

We demonstrated that the prevalence of diabetes comorbidities is high in Iranian population and that a great proportion of Iranian patients with diabetes had not reached the goal of glycemic control. Our findings provide a starting point from which to investigate the obstacles that prevent patients with diabetes from reaching metabolic targets.

Diabetes self-management programmes in older adults: a systematic review and meta-analysis

AIM

The evidence for self-management programmes in older adults varies in methodological approaches, and disease criteria. Using predetermined methodological criteria, we evaluated the effect of diabetes-specific self-management programme interventions in older adults.

METHODS

The EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials databases were searched from January 1980 to November 2013, as were reference lists from systematic reviews, meta-analyses and clinical practice guidelines. A total of 13 trials met the selection criteria, which included 4517 older adult participants; 2361 participants randomized to a diabetes self-management programme and 2156 to usual care.

RESULTS

The pooled effect on HbA(1c) was a reduction of -2 mmol/mol (-0.2%; 95% CI -0.3 to -0.1); tailored interventions [-3 mmol/mol (-0.2%; 95% CI -0.4 to -0.1)] or programmes with a psychological emphasis [-3 mmol/mol (-0.2; 95% CI -0.4 to -0.1)] were most effective. A pooled treatment effect on total cholesterol was a 5.81 mg/dl reduction (95% CI -10.33 to -1.29) and non-significant reductions in systolic and diastolic blood pressure.

CONCLUSIONS

Diabetes self-management programmes for older adults demonstrate a small reduction in HbA(1c), lipids and blood pressure. These findings may be of greater clinical relevance when offered in conjunction with other therapies.

Educational group visits for the management of chronic health conditions: a systematic review

OBJECTIVE

Review the effectiveness of group visits (appointments of multiple patients) on quality of life, function, self-efficacy, utilization, and biophysical outcomes in randomized controlled trials of patients with chronic conditions.

METHODS

We searched MEDLINE(®), Cochrane, CINAHL, and PsycINFO to January 2013 for English-language trials of educational group visits led by non-prescribing facilitators (e.g., peer educators).

RESULTS

We report on 80 arthritis/falls (n=22), asthma/COPD (n=10), CHF/hypertension (n=12), diabetes (n=29), multiple conditions (n=4), and pain (n=4) studies. We found moderate evidence of improved short-term self-efficacy in patients with arthritis (10 studies) and diabetes (10 studies). We found no consistent evidence of improved quality of life; however a moderately strong body of evidence suggests peer-led community-based programs might improve quality of life and utilization in patients with multiple chronic conditions. Meta-analyses found short- (14 studies; mean change HbA1c=-0.27, CI=-0.44, 0.11) and long-term (10 studies; mean change HbA1c=-0.23, CI=-0.44, -0.02) glycemic improvement.

CONCLUSIONS

Group visits may improve self-efficacy and glycemic control. There was little consistent evidence of improved quality of life, functional status, or utilization.

PRACTICE IMPLICATIONS

Group visits represent a reasonable alternative for educating patients with chronic illness, though varied participation/retention suggests they should not be the sole alternative.