The Effects Of Different Ways Of Self-management Education On The Blood Glucose Control Of Patients With Diabetes:a Meta-analysis

ObjectivesTo systematically evaluate the effectiveness of different ways of diabetes self-management education on patients with diabetes by systematically reviewing all the Randomized Clinical Trials(RCTs)that assessed the effectiveness of psychological interventions, educational interventions and behaviors interventions on patients with diabetes with multiple electronic databases.MethodsRandomized Clinical Trials(RCTs) are reviewed through the CBM, Wangfang, VIP and CNKI Chinese databases and Pubmed, Medline, Embase and Cochrane in English. Retrieval strategy are adapted to the different databases based on the keywords as "diabetes" "self-management management" "behaviors" educational" "psychology" and "randomized clinical trials" manual search is carried on for the latest papers. Quality assessment and data collection are done by two independent valuators and then meta-analysis is carried on with Revman 5.0.ResultsA total of 23 Randomized Clinical Trials(RCTs) were included in the present research, with the experiment group 2249 participants and control group 2268 participants. The detailed information is as follows:1.15 articles used HbAlc to evaluate the effect of different ways of self-management education on patients with diabetes, including 8 articles in the way of behavior intervention subgroup,4 in educational intervention subgroup and 3 in psychological interventional subgroup. The results of the Meta analysis is WMD95%CI-0.78[-1.14,-0.41] (P<0.05) in behavior intervention subgroup, WMD95%CI-0.55[-1.06,-0.04],(P<0.05) in in educational intervention subgroup, WMD95%CI-0.55[-1.24,0.15],(P>0.05) in psychological intervention subgroup 2.8 articles used weight to evaluate the effect of different ways of self-management education on patients with diabetes, The results of the Meta analysis is SMD95%CI-0.58[-1.09,-0.06], (P<0.05).3.3 articles used knowledge about diabetes to evaluate the effect of different ways of self-management education on patients with diabetes, with one article excluded for lack of exact data. The rest two article are in the behavior subgroup.The results of the Meta analysis is SMD95%CI 2.24[1.68,2.81], (P<0.05).4.4 articles used serum total cholesterol(TC) to evaluate the effect of different ways of self-management education on patients with diabetes, The 4 article are in the behavior subgroup.The results of the Meta analysis is WMD 95%CI-0.18 [0.36, 0.00], (P=0.05).5.3 articles used systolic pressure to evaluate the effect of different ways of self-management education on patients with diabetes, with 3 article all in the behavior subgroup.The results of the Meta analysis is WMD 95%CI 0.36[-0.07, 0.78], (P>0.05).6.2 articles used quality of life to evaluate the effect of different ways of self-management education on patients with diabetes, with one article in the behavior subgroup, one in the psychological subgroup.The results of the Meta analysis is SMD95%CI 1.23[-0.21,2.68], (P<0.05).Conclusion1. The behaviors interventions has positive effects on the HbAlc、weight、basic knowledge about diabetes、serum total cholesterol and quality of life, while no obvious changes are found on systolic pressure.2. The educational interventions have positive effects on HbAlc.3. The psychological interventions have positive effects on HbAlc and quality of life.4. Comprehensive intervention including the behavior intervention, psychological intervention and educational intervention should be implemented during the self-management education to achieve a better outcome for patient with diabetes.5. Large-scale and multi-centered randomized controlled trials are needed to confirm its effectiveness.