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Diabetes and endocrinology
Research
Supported self-management for people with type 2 diabetes: a meta-review of quantitative systematic reviews
  1. Mireille Captieux1,
  2. Gemma Pearce2,
  3. Hannah L Parke3,
  4. Eleni Epiphaniou4,
  5. Sarah Wild1,
  6. Stephanie J C Taylor5,
  7. Hilary Pinnock1
  1. 1 Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
  2. 2 Coventry University, Centre for Advances in Behavioural Science, Coventry, UK
  3. 3 University of Exeter Biomedical Informatics Hub, Exeter, Devon, UK
  4. 4 University of Nicosia, Department of Social Sciences, Nicosia, Cyprus
  5. 5 Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  1. Correspondence to Dr Hilary Pinnock; Hilary.Pinnock{at}ed.ac.uk

Abstract

Objectives Self-management support aims to give people with chronic disease confidence to actively manage their disease, in partnership with their healthcare provider. A meta-review can inform policy-makers and healthcare managers about the effectiveness of self-management support strategies for people with type 2 diabetes, and which interventions work best and for whom.

Design A meta-review of systematic reviews of randomised controlled trials (RCTs) was performed adapting Cochrane methodology.

Setting and participants Eight databases were searched for systematic reviews of RCTs from January 1993 to October 2016, with a pre-publication update in April 2017. Forward citation was performed on included reviews in Institute for Scientific Information (ISI) Proceedings. We extracted data and assessed quality with the Revised-Assessment of Multiple Systematic Reviews (R-AMSTAR).

Primary and secondary outcome measures Glycaemic control as measured by glycated haemoglobin (HbA1c) was the primary outcome. Body mass Index, lipid profiles, blood pressure and quality of life scoring were secondary outcomes. Meta-analyses reporting HbA1c were summarised in meta-forest plots; other outcomes were synthesised narratively.

Results 41 systematic reviews incorporating data from 459 unique RCTs in diverse socio-economic and ethnic communities across 33 countries were included. R-AMSTAR quality score ranged from 20 to 42 (maximum 44). Apart from one outlier, the majority of reviews found an HbA1c improvement between 0.2% and 0.6% (2.2–6.5 mmol/mol) at 6 months post-intervention, but attenuated at 12 and 24 months. Impact on secondary outcomes was inconsistent and generally non-significant. Diverse self-management support strategies were employed; no single approach appeared optimally effective (or ineffective). Effective programmes tended to be multi-component and provide adequate contact time (>10 hours). Technology-facilitated self-management support showed a similar impact as traditional approaches (HbA1c MD −0.21% to −0.6%).

Conclusions Self-management interventions using a range of approaches improve short-term glycaemic control in people with type 2 diabetes including culturally diverse populations. These findings can inform researchers, policy-makers and healthcare professionals re-evaluating the provision of self-management support in routine care. Further research should consider implementation and sustainability.

  • health policy
  • quality In health care
  • primary care
  • meta-review
  • Supported Self-management

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2018-024262

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    Footnotes

    • Contributors SJCT and HP initiated the idea for the PRISMS study, led the development of the protocol, securing of funding, study administration, data analysis and interpretation of results. EE, HLP and GP were systematic reviewers who undertook searching, selection of papers and data extraction with SJCT, HP and SW in the original PRISMS review. MC undertook the updating of the PRISMS review with GP, HLP, HP and SJCT. All authors had full access to all the data, and were involved in interpretation of the data. MC wrote the initial draft of the paper with HP and GP to which all the authors contributed. SJCT and HP are study guarantors.

    • Funding PRISMS was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 11/1014/04). HLP was supported by a Primary Care Research Career Award from the Chief Scientist’s Office of the Scottish Government at the time of the PRISMS study. MC is supported by an Academic Fellowship in General Practice from the Scottish School of Primary Care.

    • Disclaimer The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data are included in the supplementary tables.