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Group-based interventions improve clinical, psychosocial outcomes in type 2 diabetes
In patients with type 2 diabetes, group-based education interventions are more effective at improving clinical, lifestyle and psychosocial outcomes vs. usual care, waiting-list controls or individual-based education, according to a systematic review of 47 studies.
“Group-based education for individuals with type 2 diabetes mellitus may be more cost-effective and efficient than individual education, due to the reduced time and funding required to educate numerous people in one sitting,” Kate Odgers-Jewell, PhD, APD, a sessional teaching fellow at the Faculty of Health Sciences and Medicine at Bond University in Queensland, Australia, and colleagues wrote. “The potential advantages of group-based education interventions over individual visits include time for the provision of more detailed information, decreased time demands on health workers, easily incorporating families and careers, and facilitating discussions and support from others facing the same challenges. Clearly, the use of group-based education warrants further investigation.”
Odgers-Jewell and colleagues analyzed data from 47 studies published between 1988 and 2015 analyzing group-based education programs for adults with type 2 diabetes that measured HbA1c and followed participants for at least 6 months (n = 8,533; 4,416 in intervention group; mean age, 60 years; 44% men overall). The primary outcome was HbA1c in group-based interventions vs. controls; secondary outcomes included fasting blood glucose, weight, BMI, waist circumference, blood pressure, blood lipid profiles, diabetes knowledge and self-efficacy.
Researchers observed a greater reduction in HbA1c in group-based education vs. controls at 6 to 10 months in 30 studies (mean difference, 0.3%; 95% CI, –0.48 to –0.15), at 12 to 14 months in 27 studies (mean difference, 0.3%; 95% CI, –0.49 to –0.17), at 18 months in three studies (mean difference, 0.7%; 95% CI, –1.26 to –0.18) and at 36 to 48 months in five studies (mean difference, 0.9%; 95% CI, –1.52 to –0.34). There were no differences observed at 24 months.
Outcomes also favored group-based education for fasting blood glucose, body weight, waist circumference, triglyceride levels and diabetes knowledge, but not at all time points, the researchers added. Compared with peer-led interventions, those facilitated by a single discipline, multidisciplinary teams or health professionals with peer supporters resulted in improved outcomes in HbA1c, according to the researchers.
They noted that the lack of statistical significance in all but two subgroup analyses may indicate that other factors, such as peer identification and group interactions, are the “active ingredient” that influence the effectiveness of any group-based intervention in type 2 diabetes. Most studies were also classified as having a moderate or high risk for bias.
“The study resulted in statistically significant improvements in [HbA1c], fasting blood glucose, body weight, waist circumference, triglycerides and diabetes knowledge; however, the results may not be clinically important,” Odgers-Jewell told Endocrine Today. “Further research is needed to explore the effects of peer identification, normalization and group interactions on the effectiveness of group-based education interventions for the management of type 2 diabetes. Additionally, future research should explore the cost-effectiveness of group-based education programs, and the barriers and facilitators to implementing group-based education programs for the management of type 2 diabetes.” – by Regina Schaffer
For more information:
Kate Odgers-Jewell, PhD, APD, can be reached at the Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, 4229, Australia; email: kodgersj@bond.edu.au.
Disclosure: The researchers report no relevant financial disclosures.