Interventions for self-management of type 2 diabetes: An integrative review

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Abstract

Background

Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage. Since the management of diabetes is mainly accomplished by patients and families, self-management has become the mainstay of diabetes care. However, a significant proportion of patients fail to engage in adequate self-management. A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes?

Purpose/Objectives

The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with Type II diabetes mellitus.

Design

An integrative review design, with a comprehensive methodological approach of reviews, allowing inclusion of experimental and non-experimental studies.

Procedures

A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycArtiCLES, and PsycInfo. The final number of papers used for this review were: motivational interviewing (6), peer support/coaching (10), problem solving therapy (3), technology-based interventions (30), lifestyle modification programs (7), patient education (11), mindfulness (3), and cognitive behavioral therapy (5).

Results

Studies were examined from seventeen countries including a broad range of cultures and ethnicities. While interventions have shown mixed results in all interventional categories, many studies do support small to modest improvements in physiologic, behavioral, and psychological outcome measures. Considerable heterogeneity of interventions exists. The most commonly reported physiologic measure was HbA1c level. Outcome measures were collected mostly at 6 and 12 months. Duration of most research was limited to one year.

Conclusions

Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes, from offering suggestions for improving care, to stimulating new questions for research. However, implications for clinical practice remain inconclusive, and limitations in existing research suggest caution in interpreting results of studies.

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Most cited references 96

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Assessing psychosocial distress in diabetes: development of the diabetes distress scale.

William H. Polonsky, Lawrence Fisher, Jay Earles … (2005)

The purpose of this study was to describe the development of the Diabetes Distress Scale (DDS), a new instrument for the assessment of diabetes-related emotional distress, based on four independent patient samples. In consultation with patients and professionals from multiple disciplines, a preliminary scale of 28 items was developed, based a priori on four distress-related domains: emotional burden subscale, physician-related distress subscale, regimen-related distress subscale, and diabetes-related interpersonal distress. The new instrument was included in a larger battery of questionnaires used in diabetes studies at four diverse sites: waiting room at a primary care clinic (n = 200), waiting room at a diabetes specialty clinic (n = 179), a diabetes management study program (n = 167), and an ongoing diabetes management program (n = 158). Exploratory factor analyses revealed four factors consistent across sites (involving 17 of the 28 items) that matched the critical content domains identified earlier. The correlation between the 28-item and 17-item scales was very high (r = 0.99). The mean correlation between the 17-item total score (DDS) and the four subscales was high (r = 0.82), but the pattern of interscale correlations suggested that the subscales, although not totally independent, tapped into relatively different areas of diabetes-related distress. Internal reliability of the DDS and the four subscales was adequate (alpha > 0.87), and validity coefficients yielded significant linkages with the Center for Epidemiological Studies Depression Scale, meal planning, exercise, and total cholesterol. Insulin users evidenced the highest mean DDS total scores, whereas diet-controlled subjects displayed the lowest scores (P < 0.001). The DDS has a consistent, generalizable factor structure and good internal reliability and validity across four different clinical sites. The new instrument may serve as a valuable measure of diabetes-related emotional distress for use in research and clinical practice.

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Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis.

X Liang, Q. Wang, X. YANG … (2011)

To assess the effect of mobile phone intervention on glycaemic control in diabetes self-management. We searched three electronic databases (PubMed, EMBASE and Cochrane Library) using the following terms: diabetes or diabetes mellitus and mobile phone or cellular phone, or text message. We also manually searched reference lists of relevant papers to identify additional studies. Clinical studies that used mobile phone intervention and reported changes in glycosylated haemoglobin (HbA(1c) ) values in patients with diabetes were reviewed. The study design, intervention methods, sample size and clinical outcomes were extracted from each trial. The results of the HbA(1c) change in the trials were pooled using meta-analysis methods. A total of 22 trials were selected for the review. Meta-analysis among 1657 participants showed that mobile phone interventions for diabetes self-management reduced HbA(1c) values by a mean of 0.5% [6 mmol/mol; 95% confidence interval, 0.3-0.7% (4-8 mmol/mol)] over a median of 6 months follow-up duration. In subgroup analysis, 11 studies among Type 2 diabetes patients reported significantly greater reduction in HbA(1c) than studies among Type 1 diabetes patients [0.8 (9 mmol/mol) vs. 0.3% (3 mmol/mol); P=0.02]. The effect of mobile phone intervention did not significantly differ by other participant characteristics or intervention strategies. Results pooled from the included trials provided strong evidence that mobile phone intervention led to statistically significant improvement in glycaemic control and self-management in diabetes care, especially for Type 2 diabetes patients. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

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Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial.

Honor L Glenn, C. Hayes, M. Callaghan … (2007)

Patients in a low-income community health center with Type 2 diabetes (N = 81) taking a one-day education workshop as part of their diabetes medical management were randomly assigned either to education alone or to a combination of education and acceptance and commitment therapy (ACT). Both groups were taught how to manage their diabetes, but those in the ACT condition also learned to apply acceptance and mindfulness skills to difficult diabetes-related thoughts and feelings. Compared with patients who received education alone, after 3 months those in the ACT condition were more likely to use these coping strategies, to report better diabetes self-care, and to have glycated hemoglobin (HbA-sub(1C)) values in the target range. Mediational analyses indicated that changes in acceptance coping and self-management behavior mediated the impact of treatment on changes in HbA-sub(1C). Copyright 2007 APA, all rights reserved.

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Author and article information

Contributors

Roger Carpenter

Toni DiChiacchio

Kendra Barker

Journal

Journal ID (nlm-ta): Int J Nurs Sci

Journal ID (iso-abbrev): Int J Nurs Sci

Title: International Journal of Nursing Sciences

Publisher: Chinese Nursing Association

ISSN (Electronic): 2352-0132

Publication date PMC-release: 14 December 2018

Publication date Collection: 10 January 2019

Publication date (Electronic): 14 December 2018

Volume: 6

Issue: 1

Pages: 70-91

Affiliations

[a ]West Virginia University School of Nursing, Morgantown, WV, 26506, USA

[b ]Faculty Practice & Community Engagement, West Virginia University, Morgantown, WV, 26506, USA

Author notes

[∗ ]Corresponding author. rcarpenter@ 123456hsc.wvu.edu

Article

Publisher ID: S2352-0132(18)30342-9

DOI: 10.1016/j.ijnss.2018.12.002

PMC ID: 6608673

PubMed ID: 31406872

SO-VID: 93fcd989-003c-45e8-904a-436d9044982d

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 9 July 2018

Date revision received : 17 September 2018

Date accepted : 14 December 2018

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Interventions for self-management of type 2 diabetes: An integrative review

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Abstract

Background

Purpose/Objectives

Design

Procedures

Results

Conclusions

Related collections

International Journal of Applied Technology in Medical Sciences

Most cited references 96

Assessing psychosocial distress in diabetes: development of the diabetes distress scale.

Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis.

Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial.

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Cited by 39

Most referenced authors 2,789