Diabetes patient education: a meta-analysis and meta-regression
Introduction
Patient education is a cornerstone of diabetes care. National Standards for Diabetes Self-Management Education define patient education as “an exchange of knowledge, tools, and practices that will address the client’s … needs” [1]. Purposefully this definition is nonspecific and inclusive, encouraging educational processes that are adaptable and individualized. While this leaves much room for personal decision and variety in the educational process, it also leaves a process that is difficult to define and describe.
Others have attempted to better characterize educational interventions in diabetes. Earlier reviews have reported positive effects on patient knowledge, self-care behaviors, metabolic control, and psychological outcomes. Yet the most consistent finding of these previous meta-analyses was incomplete and inadequate descriptions of the interventions [2], [3], [4]. The authors use these conclusions to confirm the continued need for high quality studies and to encourage more complete and accurate descriptions of these interventions. More recent literature reviews echo these conclusions, again calling for more thorough descriptions of educational interventions [5], [6]. In follow-up of these admonitions, a framework to promote more consistent and accurate reporting of diabetes patient education interventions has been proposed [7]. This taxonomy permits systematic characterization of educational interventions in diabetes.
The main intent of this study was to characterize and assess the effect of more recent patient education interventions on glycemic control as represented by glycated hemoglobin (HbA1c). Additionally, using the taxonomy mentioned above, we systematically categorized each educational intervention and assessed the relationship between the specific variables within the interventions and metabolic control. We used the techniques of meta-regression to quantitatively analyze which components of educational interventions best explained variance in metabolic control.
Section snippets
Identification and selection of studies
We searched the MEDLINE, CINAHL, healthSTAR, ERIC, Science Citation Index, PsychINFO, and CRISP databases using the key words diabetes mellitus, education and patient education. A medical librarian performed a parallel search. We also searched the web-based database at the American Association of Diabetes Educators web site (http://www.aadenet.org). We limited our search to English language studies published between 1990 and December 2000. In an attempt to assure higher quality studies, we
Participants and patient education interventions
We identified 26 randomized controlled trials of educational interventions performed in adults with diabetes. Of these 26, five were excluded because they either were an incomplete report of a later publication [16], or did not report a measure of either standard deviation or standard error [17], [18], [19], [20]. Twenty-one articles met all of our inclusion criteria and constituted the final sample (Table 2) [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34],
Discussion
The results of this meta-analysis support that patient education improves glycemic control in patients with diabetes. The HbA1c net change was 0.32. This result is just slightly less than that of previous meta-analyses using earlier studies with a variety of study designs [2], [3], [4]. The meta-regression suggests several attributes of patient education that seem to predict improved glycemic control: face-to-face interaction; a cognitive reframing teaching method; and exercise content.
There is
Practice implications
This analysis supports the benefit of educational interventions in diabetes and suggests specific domains that may predict increased likelihood of success. Moreover, this study highlights opportunities to investigate specific attributes of educational interventions that may better impact glycemic control in adult patients with diabetes. Coordinated efforts of interventions, using specific delivery techniques, teaching methods, and content, given at a specific “dose” will better quantify the
References (43)
Meta-analysis of the effects of educational and psychosocial interventions on management of diabetes mellitus
J. Clin. Epidemiol.
(1988)- et al.
A taxonomy for diabetes educational interventions
Patient Educ. Couns.
(2001) - et al.
Meta-analysis in clinical trials
Control Clin. Trials
(1986) - et al.
Long-term effects and costs of brief behavioural dietary intervention for patients with diabetes delivered from the medical office
Patient Educ. Couns.
(1997) - et al.
The maintenance of improved metabolic control after intensified diet therapy in recent type 2 diabetes
Diabetes Res. Clin. Pract.
(1993) - et al.
Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin-dependent diabetes mellitus: a randomized, controlled clinical trial
J. Am. Diet Assoc.
(1995) - et al.
Improving self-care among older patients with type II diabetes: the sixty something … study
Patient Educ. Couns.
(1992) - et al.
National standards for diabetes self-management education. Task Force to Review and Revise the National Standards for Diabetes Self Management Education Programs
Diabetes Care
(2000) Effects of educational interventions in diabetes care: a meta-analysis of findings
Nurs. Res.
(1988)Meta-analysis of diabetes patient education research: variations in intervention effects across studies
Res. Nurs. Health
(1992)
Patient education and diabetes research: a failure! going beyond the empirical approaches
Acta Diabetol.
Self management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control
Diabetes Care
Assessing the quality of reports of randomized trials: implications for the conduct of meta-analyses
Health Technol. Assess.
Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials
J Am. Med. Assoc.
Sbe 16: meta-analyses
Stata Techn. Bull.
Sbe 16.1: new syntax and output for the meta-analysis
Stata Techn. Bull.
Meta-analysis
J. Ed. Stat.
Sbe23: meta-analysis regression
Stata Techn. Bull.
Explaining heterogeneity in meta-analysis: a comparison of methods
Stat. Med.
Effects of a brief office-based intervention to facilitate diabetes dietary self-management
Diabetes Care
Cognitive behavior therapy for depression in type 2 diabetes mellitus: a randomized, controlled trial
Ann. Intern. Med.
Cited by (363)
Pilot study to validate a standard operating procedure for providing health education to diabetic patients
2023, Journal of Taibah University Medical SciencesExercise and Lifestyle Education program for Brazilians living with prediabetes and diabetes: A pilot randomized trial
2022, Diabetes and Metabolic Syndrome: Clinical Research and ReviewsItalian guidelines for the treatment of type 2 diabetes
2022, Nutrition, Metabolism and Cardiovascular Diseases