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Behavioral programs for diabetes patients offer benefits

Behavioral interventions offer some benefits to patients with type 1 and type 2 diabetes, according to data from two reviews published in the Annals of Internal Medicine.

Jennifer Pillay, BSc, Edmonton Clinic Health Academy at the University of Alberta, and colleagues conducted meta-analyses to assess factors contributing to the efficacy of behavioral programs.

The researchers utilized research published between 1993 and January 2015 for the study on type 2 diabetes, and from 1993 to June 2015 for type 1 diabetes. They identified studies using bibliographic databases including Ovid MEDLINE, EMBASE, PubMed and others.

For their investigation regarding type 1 diabetes, Pillay and colleagues analyzed 35 prospective controlled studies.

Results showed behavioral programs were beneficial for glycemic control. Moderate strength of evidence for behavioral programs demonstrated greater reduction in HbA1c when compared with usual care (mean difference = –0.29; 95% CI, –0.45 to 0.13) and controls (mean difference = –0.44; 95% CI, –0.69 to –0.19) after 6 months.

"Current evidence does not support encouraging patients with [type 1 diabetes]to participate in behavior programs to improve outcomes apart from HbA1c," Pillay and colleagues wrote. "Program evaluation is an important component to build into the implementation of any behavioral program for diabetes to ensure that it is the correct fit for the target population. At this time, clinicians still must monitor patients after participating in these programs, should additional means be necessary to control their disease more adequately to prevent devastating complications."

In their investigation regarding type 2 diabetes, Pillay and colleagues analyzed 132 randomized studies.

Results demonstrated the majority of lifestyle and diabetes self-management education (DSME) plus support programs that offered at least 11 contact hours resulted in at least 0.4% reduction in HbA1c.

"We found that most lifestyle and DSME plus support programs led to clinically important improvements in glycemic control, but that most DSME programs without an added support component provided little benefit — particularly when 10 or fewer hours of contact with delivery personnel was provided," Pillay and colleagues wrote. "Programs that were effective most often included in-person delivery rather than incorporation of technology."

They also reported that the programs were found to be a better benefit to patients with poor glycemic control, compared to patients with good control. – by Chelsea Frajerman Pardes

Disclosures: Pillay reports grants from Agency for Healthcare Research and Quality during the conduct of the study. Please see the full study for a list of all other authors' relevant financial disclosures.