http://nevadawellness.org/wp-content/uploads/2015/06/Diabetes-self-management-education-for-adults-with-type-2-diabetes-mellitus-A-systematic-review-of-the-effect-on-glycemic-control.pdf

Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control.

Self‐care is defined as a naturalistic decision‐making process addressing both the prevention and management of chronic illness, with core elements of self‐care maintenance, self‐care monitoring, and self‐care management. In this scientific statement, we describe the importance of self‐care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self‐care behaviors such as diet and exercise, barriers to self‐care, and the effectiveness of self‐care in improving outcomes is reviewed, as is the evidence supporting various individual, family‐based, and community‐based approaches to improving self‐care. Although there are many nuances to the relationships between self‐care and outcomes, there is strong evidence that self‐care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self‐care in evidence‐based guidelines.

https://repository.upenn.edu/cgi/viewcontent.cgi?article=1104&context=nrs

Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association.

Objective The effect of lifestyle intervention on clinical risk factors in patients with type 2 diabetes is unclear. The aim of this meta-analysis was to evaluate the effects of comprehensive lifestyle change, such as diet, exercise, and education, on clinical markers that are risk-factors for cardiovascular disease in patients with type 2 diabetes. Methods We searched Medline, Cochrane, EMBASE, and Google Scholar (up to August 31, 2013) for randomized controlled trials that compared standard of care (control group) with treatment regimens that included changes in lifestyle (intervention group). The primary outcome was reduction in risk factors of cardiovascular disease including body mass index (BMI), glycated hemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c). Results A total of 16 studies were included in the meta-analysis. The standardized difference in means of change from baseline significantly favored the intervention compared with the control group in BMI (− 0.29; 95% CI, − 0.52 to − 0.06, P = 0.014), HbA1c (− 0.37; 95% CI, − 0.59 to − 0.14, P = 0.001), SBP (− 0.16: 95% CI, − 0.29 to − 0.03, P = 0.016), DBP (− 0.27, 95% CI = − 0.41 to − 0.12, P  Conclusions The meta-analysis found that lifestyle intervention showed significant benefit in risk factors that are known to be associated with development of cardiovascular disease in patients with type 2 diabetes.

Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis.

Background Behavioral programs may improve outcomes for individuals with type 2 diabetes mellitus, but there is a large diversity of behavioral interventions and uncertainty about how to optimize the effectiveness of these programs. Purpose To identify factors moderating the effectiveness of behavioral programs for adults with type 2 diabetes. Data sources 6 databases (1993 to January 2015), conference proceedings (2011 to 2014), and reference lists. Study selection Duplicate screening and selection of 132 randomized, controlled trials evaluating behavioral programs compared with usual care, active controls, or other behavioral programs. Data extraction One reviewer extracted and another verified data. Two reviewers independently assessed risk of bias. Data synthesis Behavioral programs were grouped on the basis of program content and delivery methods. A Bayesian network meta-analysis showed that most lifestyle and diabetes self-management education and support programs (usually offering ≥ 11 contact hours) led to clinically important improvements in glycemic control (≥ 0.4% reduction in hemoglobin A1c [HbA1c]), whereas most diabetes self-management education programs without added support-especially those offering 10 or fewer contact hours-provided little benefit. Programs with higher effect sizes were more often delivered in person than via technology. Lifestyle programs led to the greatest reductions in body mass index. Reductions in HbA1c seemed to be greater for participants with a baseline HbA1c level of 7.0% or greater, adults younger than 65 years, and minority persons (subgroups with ≥ 75% nonwhite participants). Limitations All trials had medium or high risk of bias. Subgroup analyses were indirect, and therefore exploratory. Most outcomes were reported immediately after the interventions. Conclusion Diabetes self-management education offering 10 or fewer hours of contact with delivery personnel provided little benefit. Behavioral programs seem to benefit persons with suboptimal or poor glycemic control more than those with good control. Primary funding source Agency for Healthcare Research and Quality. (PROSPERO registration number: CRD42014010515).

Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis.

This network meta-analysis of 132 randomized trials identifies important components and characteristics of successful behavioral programs for adults with type 2 diabetes.

Behavioral Programs for Type 2 Diabetes Mellitus

Knowledge of factors associated with the use of technology could inform the design of technology-based behavioral interventions. This study examined modifiable and nonmodifiable factors associated with technology-based self-monitoring. 123 participants with type 2 diabetes self-monitored diet using a personal digital assistant in a 6-month behavioral intervention. Multinomial logistic regression was used to examine probability of nonadherent and suboptimally adherent behavior relative to adherent behavior. Sociodemographic characteristics were not associated with probability of self-monitoring. Probability of adherence generally was greater in the weeks preceding no group session, and lower in the weeks following no group session or following skipped sessions. Non-modifiable factors suggested by the literature to be associated with poorer access to technology (lower income, older age, minority race, and lower education) were not associated with probability of self-monitoring in this population.

Factors associated with probability of personal digital assistant-based dietary self-monitoring in those with type 2 diabetes

Abstract Objectives The application effect of the trans-theoretical model (TTM) of behavior change in diabetic kidney disease (DKD) patients treated with maintenance hemodialysis (MHD) was discussed. Methods According to the random number table method, 80 patients with DKD on MHD were divided into control group and observation group, 40 patients in each group. Results After the intervention for 6 months, the self-rating depression scale (SDS) and self-rating anxiety scale (SAS) scores of patients in the observation group were all lower than those before the intervention and those in the control group (P < 0.05); the compliance of patients to fluid intake in the observation group was higher than that in the control group while the total incidence rate of associated acute complications of the former was lower than that of the latter (P < 0.05). The fasting blood glucose (FBG) and 2-h postprandial blood glucose (2hPBG) indexes of the observation group were lower than those of the control group (P < 0.05), and the laboratory test indexes of serum creatinine (SCr), blood urea nitrogen (BUN), glomerular filtration rate (GFR) were lower than those before the intervention and lower than those of the control group (P < 0.05). Conclusions The nursing combined with TTM of behavior change can effectively strengthen the compliance of DKD patients subjected to MHD to fluid intake, reduce patients’ negative moods (such as depression and anxiety), and lower the incidence rate of complications, and improve the life quality.

The application effect of the trans-theoretical model of behavior change in diabetic kidney disease patients treated with maintenance hemodialysis

Biophysiologic Outcomes of the Enhancing Adherence in Type 2 Diabetes (ENHANCE) Trial

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Factors associated with probability of personal digital assistant-based dietary self-monitoring in those with type 2 diabetes

The application effect of the trans-theoretical model of behavior change in diabetic kidney disease patients treated with maintenance hemodialysis

Biophysiologic Outcomes of the Enhancing Adherence in Type 2 Diabetes (ENHANCE) Trial