Table 1 Characteristics of studies included in the systematic review of randomized controlled trials assessing group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus
Author Year, Country, | Number of participants recruited / at follow-up | Mean age (SD or range) years | Mean duration of diabetes (years) | Mean (SD) % HbA1c at baseline (Intervention / Control) | Inclusion criteria | Intervention | Follow-up (months or years) | Risk of bias |
|---|---|---|---|---|---|---|---|---|
Adolfsson 2007, Sweden | 101/88 | 63.0 (9.0) | 6.6 (4.1) | 7.1 (1.0)/ 7.1 (0.8) | Diabetes type 2 duration of at least 1 year, receiving dietary or oral anti-diabetes treatment | 4-5 sessions of 2.5 hours each and one follow-up session within 28 weeks, (12.5 hours), by trained physicians and diabetes specialist nurses | 1 year | Low |
Baradaran 2006, UK | 118/80 | 58.5 (12.0) | 9.0 (7.5) | Not stated | South Asians, type 2 diabetes, > 30 years of age | 3 sessions of 2,5 hours + 25 minutes information video (7.5 hours), by dietician and podiatrist | 6 months | Moderate |
Brown 2002, USA | 256/230 | 54.1 (8.3) | 7.9 (6.4) | 11.8 (3.0)/11.8 (3.0) | Mexican Americans | 52 hours over 12 months (3 mths of weekly 2 hrs sessions, 6 mths of biweekly 2 hrs sessions, 3 mths of monthly 2 hrs sessions), by nurse, dietician & community worker | 1 year | High |
35-70 years, diagnosed with Type 2 diabetes, 2 measures of FBG > 140 mg/dl, taken insulin or oral hypoglycaemic agents for >1 year | ||||||||
Cabrera-Pivaral 2004, Mexico, | 49/49 | 58.0 (10.6) | 10.0 (10.4) | Not stated | Hispanics, obese type 2 diabetics | 82 hours over 9 months (2 hours/week), by social worker and nutritionist | 9 months | High |
Clancy 2007, USA | 186/159 | 56 (8.9) | Not stated | 9.3 (2.0)/ 8.9 (2.1) | African Americans with poorly controlled diabetes type 2 (HbA1c > 8.0 %), | 1 group visit/month for 12 months, 2 hours/visit (24 hours), by physician and registered nurse. | 1 year | Moderate |
Cooper 2003, UK | 89/Not stated | 58 (30-73) | 6 (1-30) | 7.9 (1.7)/ 7.0 (1.6) | Type 2 diabetics, oral hypoglycaemic agents treatment | 8 weekly sessions for 2 hours (16 hours), by diabetes specialist nurses | 1 year | Moderate |
Deakin 2006, UK | 314/291 | 61.6 (10.4) | 6.7 (6.6) | 7.7 (1.6)/ 7.7 (1.6) | Adults with type 2 diabetes identified from practice registers using WHO criteria | 2 hours per week for 6 weeks (12 hours), by diabetes research dietician/diabetes educator | 14 months | Low |
Heller 1988, UK | 87/75 | 56.4 (8.5) | Not stated | 12.3 (2.8)/ 12.7 (2.5) | Newly diagnosed age 30-75 yrs | 4.5 hr for 3 consecutive weeks, 1.5 hr at both 3 & 6 months (7.5 hours), by diabetes nurses and a dietician | 1 year | Moderate |
Holtrop 2002, USA | 132/88 | 61.5 (No SD or range) | Not stated | 8.0 (1,34)/ 7.7 (1,34) | More than 40 years, female type 2 diabetics, HbA1c > 7 % in past 6 months | Six weekly 1 1/2 hour sessions (9 hours), by trained lay health advisors | 6 months | Moderate |
Hornsten 2004, Sweden | 104/99 | 63.5 (9.2) | Not stated | 5.7 (0.8)/ 5.8 (0.7) | Aged 40 - 80 years, diagnosed with type 2 diabetes during the previous 2 years. Oral, guts and/or insulin, and diet treatment | 10 group sessions, 2 hours/session for 9 months (20 hours), by diabetes nurses | 1 year | Moderate |
Lozano 1999, Spain | 243/234 | 64.3 (11.2) | 8.6 (8.3) | 6.6 (1.4)/ 6.7 (1.3) | Type 2 diabetes | 1 hr 30 min/day for two consecutive days (3 hours), and further education in year two, by nurses | 2 years | Moderate |
Lujan 2007, USA | 149/140 | Not stated | Not stated | 8.2 (2.2)/ 7.7 (1.5) | 40 years of age or older, Self reported Mexican-American ethnicity, Diagnosed with type 2 diabetes for at least 1 year, Taking or having taken hypoglycemic agents within the past 6 months. | 2 hour long sessions for 8 weeks (16 hours) plus biweekly telephone, by Promotoras (Community lay workers) | 6 months | High |
Mayer-Davies 2004, USA | 152/ Not stated | 60.4(8.7) | 11.0 (9.4) | 9.7 (2.8)/9.6 (2.9) | Clinical diagnosis of diabetes, BMI of 25 kg/m2 or greater during the previous calendar year | Intense: 1 hour weekly for four mths, biweekly for two mths and once every moth for six mths, by Nutritionist | 1 year | High |
Reimbursable: Four 1 hour sessions (3 group sessions & 1 individual session) over 12 months, by Nutritionist | ||||||||
McKibbin 2006, USA | 64/57 | 54.0 (9.3) | 8.7 (6.2) | 7.4 (2.9)/ 6.7 (2.1) | Older schizophrenic patients. Diet, Oral agents, and Insulin treatment | 24 weekly 90 minute sessions for 6 months (36 hours). | 6 months | Moderate |
Pennings-van der 1991, Netherlands | 118/83 | 64.4 (9.6) | 10.9 (7.6) | 8.0 (1.8)/ 7.6 (1.5) | Diabetes mellitus type Il treated with diet and/or oral agents | 7 half-day meetings in 7 weeks, by physicians, dieticians, diabetologist, diabetes nurse | 8 months | High |
Rosal 2005, USA | 25/Not stated | 62.6 (8.7) | 8.2 (5.6) | 7.7 (1.2)/ 9.3 (1.8) | Hispanics. Diet, Oral hypoglycemic agents, Insulin, Alternative medicines treatment | Initial 1 hour individual session, followed by 10 weekly 2.5 to 3 hour group sessions and two 15 minute individual sessions that occurred immediately prior to the group session (30 hours), by Diabetes nurse, Nutritionist and an Assistant | 6 months | High |
Sarkadi 2004, Sweden | 77/64 | 66.4 (9.3) | 4.3 (4.0) | 6.5 (1.5)/ 6.4 (1.5) | Type 2 diabetes, treated with insulin only for 2 year or less | Meetings every months over 12 months, by Pharmacists assisted by Diabetes nurse specialists the two first meetings | 2 years | Moderate |
Toobert 2003/2007, USA | 279/215 | 60.9 (7.9) | 8.3 (7.7) | 7.4 (1.3)/ 7.4 (1.5) | Female, Diagnosis of type 2 diabetes for at least 6 months, Postmenopausal, | 3 days non-residential retreat, followed by 4-hour weekly meetings for 6 months | Moderate | |
Trento 1998/2001/2002/2004, Italy | 112/84 | 61.5 (30-80) | 9.6 (1-39) | 7.2 (1.3)/ 7.3 (1.4) | Treated with diet or oral hypoglycaemic agents, followed in clinic >1 year | Every 3 months for 1 year (4 x 60/70 min), and 15-30 min. individually for those who developed specific problems[51]; every 3 months for 2 years (1 hour x 8 = 8 hr/2 yr) ([52]); every 3 months for 2 years and 7 sessions in year 3 +4 (total 15 hrs/4 yrs) ([53]); every 3 months for 2 years and 7 sessions in year 3and 4 (total 15 hrs/4 yrs) and started again in year 5 ([54]), by Two physicians and educationist | 1 year [51], 2 years ([52]), 4 years ([53]), 5 years ([54]) | Moderate |
Wattana 2007, Thailand | 157/147 | 56.8 (10.1) | 6.2 (5.0) | 8.1 (1.9)/ 8.1 (2.0) | 35 years or older, Diagnosed with type 2 diabetes for at least 6 months, Fasting plasma glucose level >140 mg for at least 2 follow up visits, Asian participants. Oral hypoglycaemic agents treatment | 120 minutes small group diabetes education class, 4 small group discussions (90 mins/group), two 45 minutes home visits by the researcher | 6 months | Moderate |
Zapotoczky 2001, Austria | 36/36 | 57.5 (9.8) | Not stated | 8.6 (1.6)/ 8.0 (1.5) | Not stated | 1.5 hours monthly for 10 months (15 hours) delivered by a dietician | 1 years | High |