Diabetes self-management programmes in older adults: a systematic review and meta-analysis

Diabet Med. 2015 Nov;32(11):1404-14. doi: 10.1111/dme.12780. Epub 2015 Apr 29.

Abstract

Aim: The evidence for self-management programmes in older adults varies in methodological approaches, and disease criteria. Using predetermined methodological criteria, we evaluated the effect of diabetes-specific self-management programme interventions in older adults.

Methods: The EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials databases were searched from January 1980 to November 2013, as were reference lists from systematic reviews, meta-analyses and clinical practice guidelines. A total of 13 trials met the selection criteria, which included 4517 older adult participants; 2361 participants randomized to a diabetes self-management programme and 2156 to usual care.

Results: The pooled effect on HbA(1c) was a reduction of -2 mmol/mol (-0.2%; 95% CI -0.3 to -0.1); tailored interventions [-3 mmol/mol (-0.2%; 95% CI -0.4 to -0.1)] or programmes with a psychological emphasis [-3 mmol/mol (-0.2; 95% CI -0.4 to -0.1)] were most effective. A pooled treatment effect on total cholesterol was a 5.81 mg/dl reduction (95% CI -10.33 to -1.29) and non-significant reductions in systolic and diastolic blood pressure.

Conclusions: Diabetes self-management programmes for older adults demonstrate a small reduction in HbA(1c), lipids and blood pressure. These findings may be of greater clinical relevance when offered in conjunction with other therapies.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Aging*
  • Cholesterol / blood
  • Combined Modality Therapy
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / therapy*
  • Diabetic Angiopathies / prevention & control
  • Glycated Hemoglobin A / analysis
  • Group Processes
  • Humans
  • Hypercholesterolemia / complications
  • Hypercholesterolemia / prevention & control*
  • Hyperglycemia / prevention & control*
  • Hypertension / complications
  • Hypertension / prevention & control*
  • Patient Education as Topic*
  • Precision Medicine
  • Randomized Controlled Trials as Topic
  • Self Care*

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human
  • Cholesterol