In a nutshell
This analysis examined the effects of behavioral programs on the health outcomes of patients with type 1 diabetes (T1D). The authors concluded that behavioral programs for T1D offer some benefit for glycemic (blood sugar level) control.
Some background
People with diabetes are encouraged to adopt self-care behaviors such as careful self-monitoring and regulation of blood sugar levels through insulin dosing, diet and physical activity. This can be challenging for patients. Doctors and nurses must find ways to support patients and promote self-care behaviors.
Approaches for supporting patients include Diabetes Self-Management Education (DSME). This is an ongoing behavioral program that facilitates the knowledge and ability needed for diabetes self-care. It incorporates a patient’s needs, goals and life experiences. The overall objectives of DSME are to support informed self-care behaviors, problem solving and teamwork with the health care team. However, whether behavioral approaches for self-care benefit individuals with T1D is still unclear.
Methods & findings
The current analysis looked at the effects of behavioral programs on the health outcomes of patients with T1D. 36 studies were included in the analysis. 27 studies were conducted in youths and 9 in adults. The studies compared DSME with standard care.
After 6 months there was a 0.44% reduction in HbA1c (measurement of average blood glucose levels over 3 months) levels for those who received the behavioral program compared with those who received standard care. This difference was not significant by 12 months.
The benefit in blood sugar level control after the behavioral program appeared to be greater in adults than in youths. The level of evidence was too low for other health outcomes (changes in diet, physical activity or diabetes self-management) to be able to determine if there was a benefit or not.
The bottom line
The analysis concluded that behavioral programs for T1D offer some benefit for glycemic control, particularly in adults, but improvements in other health outcomes (e.g. changes in diet, physical activity or diabetes self-management) have not been shown.
The fine print
There were variations in what was considered standard care in the studies, and some may have been more involved than others. Better reporting of what is considered standard care would allow researchers to greater understand the differences that are seen between studies.
What’s next?
Ask your doctor about the resourses that are available to support self-care and self-monitoring of T1D.
Published By :
Annals of internal medicine
Date :
Sep 29, 2015
