Jennifer Pillay, BSc; Marni J. Armstrong, PhD, RCEP; Sonia Butalia, MD, MSc; Lois E. Donovan, MD; Ronald J. Sigal, MD, MPH; Ben Vandermeer, MSc; Pritam Chordiya, BDS, MSc; Sanjaya Dhakal, MBBS, MPH; Lisa Hartling, PhD; Megan Nuspl, BSc; Robin Featherstone, MLIS; Donna M. Dryden, PhD
Disclaimer: The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the AHRQ or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank AHRQ task order officer Aysegul Gozu, MD, MPH, and AHRQ associate editor Jonathan Treadwell, PhD, who reviewed our review protocol and the full report submitted to AHRQ, for their ongoing support. We also thank the key informants and technical expert panel members (listed in the full report online at www.effective healthcare.ahrq.gov/reports/final.cfm) who provided input into the review. Several technical expert panel members also provided peer review of the draft report submitted to AHRQ and available online.
Grant Support: By the AHRQ (contract 290-2012-000131); a New Investigator Salary Award from the Canadian Institutes of Health Research (Dr. Hartling); doctoral awards from the Alliance for Canadian Health Outcomes for Research in Diabetes, Alberta Innovates–Health Solutions, and the University of Calgary–Eyes High program (Dr. Armstrong); and a Health Senior Scholar award from Alberta Innovates–Health Solutions (Dr. Sigal).
Disclosures: Ms. Pillay reports grants from AHRQ during the conduct of the study. Dr. Sigal reports salary support from Alberta Innovates-Health Solutions (Health Senior Scholar salary award) during the conduct of the study. Mr. Vandermeer reports grants from AHRQ during the conduct of the study. Dr. Chordiya reports grants from AHRQ during the conduct of the study. Ms. Nuspl reports grants from AHRQ during the conduct of the study. Ms. Featherstone reports grants from AHRQ during the conduct of the study. Dr. Dryden reports other from AHRQ (contract between AHRQ and research group to prepare a report on the topic; this publication represents one part of the report) during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1400.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol: PROSPERO registration number CRD42014010515. Statistical code and data set: Available from Ms. Pillay (e-mail, email@example.com).
Requests for Single Reprints: Jennifer Pillay, BSc, Alberta Research Centre for Health Evidence, Department of Pediatrics, 4th Floor, Edmonton Clinic Health Academy, University of Alberta, 11405 87th Avenue, Edmonton, Alberta T6G 1C9, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Ms. Pillay, Mr. Chordiya, Dr. Dhakal, Mr. Vandermeer, Dr. Hartling, Ms. Nuspl, Ms. Featherstone, and Dr. Dryden: Alberta Research Centre for Health Evidence, Department of Pediatrics, 4th Floor, Edmonton Clinic Health Academy, University of Alberta, 11405 87th Avenue, Edmonton, Alberta T6G 1C9, Canada.
Drs. Armstrong, Butalia, Donovan, and Sigal: Division of Endocrinology and Metabolism, University of Calgary, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta T2T 5C7, Canada.
Author Contributions: Conception and design: J. Pillay, M.J. Armstrong, S. Butalia, L.E. Donovan, R.J. Sigal, L. Hartling, R. Featherstone, D.M. Dryden.
Analysis and interpretation of the data: J. Pillay, M.J. Armstrong, S. Butalia, L.E. Donovan, B. Vandermeer, P. Chordiya, S. Dhakal, L. Hartling, D.M. Dryden.
Drafting of the article: J. Pillay, S. Butalia, B. Vandermeer, P. Chordiya, S. Dhakal, M. Nuspl, R. Featherstone.
Critical revision of the article for important intellectual content: J. Pillay, M.J. Armstrong, S. Butalia, L.E. Donovan, R.J. Sigal, B. Vandermeer, L. Hartling, D.M. Dryden.
Final approval of the article: J. Pillay, M.J. Armstrong, S. Butalia, L.E. Donovan, R.J. Sigal, B. Vandermeer, P. Chordiya, S. Dhakal, L. Hartling, M. Nuspl, R. Featherstone, D.M. Dryden.
Statistical expertise: B. Vandermeer.
Obtaining of funding: S. Butalia, L. Hartling, D.M. Dryden.
Administrative, technical, or logistic support: J. Pillay, M. Nuspl, R. Featherstone, D.M. Dryden.
Collection and assembly of data: J. Pillay, P. Chordiya, S. Dhakal, L. Hartling, M. Nuspl, R. Featherstone, D.M. Dryden.
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.
To identify factors moderating the effectiveness of behavioral programs for adults with type 2 diabetes.
6 databases (1993 to January 2015), conference proceedings (2011 to 2014), and reference lists.
Duplicate screening and selection of 132 randomized, controlled trials evaluating behavioral programs compared with usual care, active controls, or other behavioral programs.
One reviewer extracted and another verified data. Two reviewers independently assessed risk of bias.
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).
All trials had medium or high risk of bias. Subgroup analyses were indirect, and therefore exploratory. Most outcomes were reported immediately after the interventions.
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.
Agency for Healthcare Research and Quality. (PROSPERO registration number: CRD42014010515)
Pillay J, Armstrong MJ, Butalia S, et al. Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis. Ann Intern Med. 2015;163:848–860. [Epub ahead of print 29 September 2015]. doi: https://doi.org/10.7326/M15-1400
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Published: Ann Intern Med. 2015;163(11):848-860.
Published at www.annals.org on 29 September 2015
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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