Background
Methods
Search strategy
Inclusion and exclusion criteria
Study selection
Data extraction
Bias and quality appraisal
Meta-analysis
Results
Citation | Sample (N) | African-American (%) | Female (%) | Mean Age | Design | Intervention Characteristics: (Duration, Contact Hours, Group vs. Individual, Provider Type) | Control | Attrition Rate | Cultural Tailoring? | HbA1c, QOL Measures |
---|---|---|---|---|---|---|---|---|---|---|
Agurs-Collins et al., 1997 [29] | 66 | 100 | 77 | 62 | RCT | 12 weekly group sessions (60 mins nutrition, 30 mins exercise) and 1 individual diet counseling session over first 3 months; 6 bi-weekly sessions over next 3 months. Providers: Registered dietician and exercise physiologist | 1 class within 3 weeks of enrollment (glycemic control); 2 nutritional mailings at 3 and 6 months | 15% | Yes | HbA1c: 3×’s: screening/randomization, 3 month visit, 6 month visit; QOL: N/A |
Amoako et al., 2008 [42] | 68 | 100 | 100 | 61 | RCT | 4 weeks of phone interventions (1 x per week, from 10 to 60 min) that included 4 phases: Warm-up, assessment of problems, uncertainty appraisal, discussion of strategies to manage uncertainty. Provider: nurse practitioner | Usual care -regular primary care and specialist visits; support group meetings; diabetes management classes | 7.35% | No | HbA1c: No specific measurements mentioned, QOL: 2×’s: baseline, 6 weeks post baseline; (Tools: Michel Uncertainty in Illness Scale; Problem Areas in Diabetes Survey). |
Anderson et al., 2005 [30] | 239 | 100 | 82 | 61 | RCT | 6 weekly 2 h group sessions; then option for monthly support group, or receive a monthly phone call. Provider: diabetes educator | Wait-listed usual care, no description given. | 6.41% | Yes | HbA1c: 4×’s:screening, after 6 week intervention and 6 week control period, 6 months post treatment, 1 year post treatment;QOL: 2×’s: baseline, 6 weeks; (Tool: Diabetes Empowerment Scale Short-Form (DESSF)). |
Anderson-Loftin et al., 2005 [31] | 97 | 100 | 76.5 | 49 | RCT | 4 weekly classes in low fat dietary strategies; 5 monthly peer-group discussions, and weekly phone follow up. Provider: diabetes educator | Referral to a local 8 h traditional diabetes class | 34.02% | Yes | HbA1c: 2×’s: baseline, 6 months post treatment; QOL: N/A |
Bray et al., 2013 [32] | 727 | 100 | 64.5 | 60 | RCT | Each patient seen 4 times over a 12 month period by the nurse, pharmacist, or dietician care manager for 30 to 60 min; follow-up with case manager every 3 to 6 mos for 2 ys. Providers: nurse, pharmacist and diabetes educator | One 15 min office visit to a physician, nurse practitioner, or physician assistant for labs; frequent diabetes educational handouts received. | 7.02% | Yes | HbA1c: 3×’s: baseline, 18 months, 36 months, QOL: N/A |
Carter et al., 2011 [33] | 47 | 100 | 63.8 | 51 | RCT | Telehealth nurse visits: bi-weekly, 30 min video conferencing; DSME modules with social networking to share coping strategies, ask questions. Provider: nurse educator | Usual care from providers | 63% | No | HbA1c: 2×’s: baseline, conclusion of 9 month study QOL: 2×’s: baseline, conclusion of 9 month study;(Tool: not specified) |
Gaillard et al., 2015 [34] | 96 | 100 | 70 | 60 | RCT | Didactic lectures at 1–2 week intervals for 6 months; individual one-on-one counseling; trained community health worker support via weekly phone calls and community resources; quarterly point of care physiological testing. Providers: Diabetes educators, registered dietitian, diabetologists,and community health worker | Usual care -anthropometric and metabolic measurements at quarterly intervals | 21% | Yes | HbA1c: 3×’s: baseline, 3 months, 6 months QOL: 2×’s: baseline, 6 months; (Tools: Questionnaire diabetic quality of life, 12-Item Short Form Survey (SF-12), diabetes attitude). |
Gary et al., 2004 [35] | 186 | 100 | 76 | 59 | RCT | 4 arms: A) usual care; B) usual care + nurse case manager (45 min face-to-face or phone); C) usual care + community health worker (45–60 min face-to-face or phone); D) usual care + nurse case manager + community health worker (3 visits with each educator per year). Providers: nurse care manager, community health worker | Ongoing care from patient’s own health care provider, quarterly newsletter | 16% | Yes | HbA1c: 2×’s: baseline; 2 yr. follow up QOL: N/A |
Keyserling et al., 2002 [36] | 200 | 100 | 100 | 59 | RCT | 3 arms: (Group A) clinic and community-based center; (Group B) clinic only; (Group C) minimal intervention. Groups A and B received 4 monthly visits with a nutritionist at clinic. In addition, Group A received 3 group sessions at community based center and 12 monthly peer phone calls.. Providers: physical activity leader, peer counselor | Received mailed pamphlets | 15% | Yes | HbA1c: 3×’s: baseline, 6 months, 12 months QOL: 3×’s: baseline, 6 months, 12 months; (Tools: Mental Well-Being, Social Well-Being). |
Peña-Purcell et al., 2015 [37] | 103 | 100 | 79.5 | 63 | QE | 6 week group educational sessions. Providers: Trained registered nurse, registered dietitian, or a certified diabetes educator | Original study design: Wait-listed control group; due to lack of participants in control group, pre/post design utilized with intervention group. | 44% | Yes | HbA1c: 2×’s: baseline, 12 weeks (3 mos); QOL: 2×’s: baseline, 5 weeks; (Tools: Psychological Distress Scale; Healthy Days Measure Scale). |
Ruggiero et al., 2014 [38] | 266 | 52.6 | 68.8 | 53 | RCT | 12 months medical assistant coaching for DSME; quarterly in-person contact at regular clinic visits, monthly follow-up phone calls. Providers: medical assistants | Treatment as usual: regular visits with primary care, referrals for specialty care, basic DSME education, diabetes pamphlet | 21.6% | Yes | HbA1c: 3×’s: baseline; 6 mos; 12 mos; QOL: N/A |
Samuel-Hodge et al., 2009 [39] | 201 | 100 | 64% | 59 | RCT | Church-based DSME: 1 individual counseling visit;12 bi-weekly group sessions; 12 monthly phone contacts; 3 encouragement postcards. Providers: peer counselor, dietician, other health care providers | Minimal care: direct mailings of 2 pamphlets, and 3 bimonthly newsletters to controls | 13.7% | Yes | HbA1c: 3×’s: baseline, 8 mos, 12 mos; QOL: N/A |
Skelly et al., 2005 [40] | 41 | 100 | 100 | 62 | RCT | 4 bi-weekly home visits lasting approximately 1 h; 4 Diabetes Symptom-Focused Management Intervention modules. Provider: nurse | 2 pre-intervention visits; 1 phone call; 1 final evaluation visit. | 8.5% | Yes | HbA1c: 2×’s: baseline, within 1 month of treatment completion QOL: 2×’s: baseline, final evaluation; (Tools: Diabetes Symptom Distress Scale (DSDS), Quality of Life in Diabetes Instrument). |
Walker et al., 2010 [41] | 195 | 100 | 80.35% | 60 | QE | Three 2-h DSME sessions with inclusion of healthy snacks. Providers: diabetes educators | Usual care | Not specified | Yes | HbA1c: 2×’s: baseline, 5 months later QOL: 2 - 3×’s; (Tools: Problem Areas in Diabetes Survey -baseline, after completion of 3 sessions, 5 months later). |
Meta-analysis results
Variable | No. of Studies | Mean HbA1c Reduction | 95% Confidence Interval | Cochran Q; P Value |
I
2
|
---|---|---|---|---|---|
Culturally tailored DSME | |||||
Yes | 7 | −.07 | [−.41,0.27] | 84.73, <.001 | 93% |
No | 1 | −.20 | [−.78,.38] | N/A | N/A |
DSME curriculum delivery | |||||
Individual | 3 | .12 | [−.81,1.06] | 36.33, <.001 | 94% |
Group | 2 | −.35 | [−1.53,.08] | 5.65, .02 | 82% |
Combination | 3 | −.18 | [−.57,.21] | 28.98, <.001 | 93% |
Intervention contact hours | |||||
< 10 | 2 | −.13 | [−.62,.35] | 9.36, .002 | 89% |
≥ 10 | 6 | −.15 | [−.73,.44] | 58.69, <.001 | 91% |
DSME provider type | |||||
Single-type | 2 | .02 | [−1.89,1.92] | 17.37, <.001 | 94% |
Multiple | 6 | −.17 | [−.42,.08] | 33.12, <.001 | 85% |
Attrition rate | |||||
< 20% | 5 | −.17 | [−.44,.11] | 33.05, <.001 | 88% |
≥ 20% | 3 | −.03 | [−1.17,1.10] | 24.03, <.001 | 92% |