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Effectiveness of group-based self-management education for individuals with type 2 diabetes: a systematic review with meta-analyses and meta-regression

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Odgers‐Jewell, K., Ball, L. E., Kelly, J. T., Isenring, E. A., Reidlinger, D. P., Thomas, R.·2017·Diabetic Medicine
DOI 10.1111/dme.13340
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Abstract

Aims: Patient education for the management of Type 2 diabetes can be delivered in various forms, with the goal of promoting and supporting positive self‐management behaviours. This systematic review aimed to determine the effectiveness of group‐based interventions compared with individual interventions or usual care for improving clinical, lifestyle and psychosocial outcomes in people with Type 2 diabetes. Methods: Six electronic databases were searched. Group‐based education programmes for adults with Type 2 diabetes that measured glycated haemoglobin (HbA 1c) and followed participants for ≥ 6 months were included. The primary outcome was HbA 1c, and secondary outcomes included fasting blood glucose, weight, body mass index, waist circumference, blood pressure, blood lipid profiles, diabetes knowledge and self‐efficacy. Results: Fifty‐three publications describing 47 studies were included (n = 8533 participants). Greater reductions in HbA 1c occurred in group‐based education compared with controls at 6–10 months [n = 30 studies; mean difference (MD) = 3 mmol/mol (0.3%); 95% confidence interval (CI): −0.48, −0.15; P = 0.0002], 12–14 months [n = 27 studies; MD = 4 mmol/mol (0.3%); 95% CI: −0.49, −0.17; P < 0.0001], 18 months [n = 3 studies; MD = 8 mmol/mol (0.7%); 95% CI: −1.26, −0.18; P = 0.009] and 36–48 months [n = 5 studies; MD = 10 mmol/mol (0.9%); 95% CI: −1.52, −0.34; P = 0.002], but not at 24 months. Outcomes also favoured group‐based education for fasting blood glucose, body weight, waist circumference, triglyceride levels and diabetes knowledge, but not at all time points. Interventions facilitated by a single discipline, multidisciplinary teams or health professionals with peer supporters resulted in improved outcomes in HbA 1c when compared with peer‐led interventions. Conclusions: Group‐based education interventions are more effective than usual care, waiting list control and individual education at improving clinical, lifestyle and psychosocial outcomes in people with Type 2 diabetes.

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  • In a systematic review, patient education for diabetes mellitus has been suggested to be cost-effective and to reduce complications and overall mortality.

    “In a systematic review, patient education for those with DM has been suggested to be both cost-effective1456,1457 as well as to reduce complications and overall mortality.1458,1453”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1457]

    The Introduction (page unavailable) suggests that group-based education for people with type 2 diabetes may be more cost-effective than individual education. It describes preventing complications and reducing mortality as goals of patient education, not as outcomes demonstrated by this review; the review’s reported results concern measures such as HbA1c. The citing sentence places separate citations after those outcome claims, but does not identify which citation refers to this paper. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • DSMES is cost-effective.

    “High-quality evidence has consistently shown that DSMES signi fi cantly improves knowledge, glycemic levels, and clinical and psychological outcomes, reduces hospital admissions and all-cause mortality, and is cost-effective (22,25 -30).”

    From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [28]

    The Introduction (page not supplied) says group-based education for people with type 2 diabetes may be more cost-effective than individual education because it requires less time and funding. That qualified comparison does not establish the broader, unqualified claim that DSMES is cost-effective. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • High-quality evidence has consistently shown that DSMES significantly improves knowledge, glycemic levels, and clinical and psychological outcomes.

    “High-quality evidence has consistently shown that DSMES signi fi cantly improves knowledge, glycemic levels, and clinical and psychological outcomes, reduces hospital admissions and all-cause mortality, and is cost-effective (22,25 -30).”

    From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [28]

    The paper reports significant improvements in diabetes knowledge and an overall reduction in HbA1c with group-based education for people with type 2 diabetes (knowledge results; ‘Overall effects of group-based interventions for HbA1c’; page unavailable). But it reports no significant improvement in self-efficacy and mixed results for other clinical measures (‘Accepted Article’; page unavailable). It therefore does not support the claim that DSMES consistently improves clinical and psychological outcomes broadly. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • DSMES reduces hospital admissions and all-cause mortality.

    “High-quality evidence has consistently shown that DSMES signi fi cantly improves knowledge, glycemic levels, and clinical and psychological outcomes, reduces hospital admissions and all-cause mortality, and is cost-effective (22,25 -30).”

    From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [28]

    The Introduction (page unavailable) names reducing morbidity and mortality as a goal of diabetes education, not a demonstrated effect. The results passages report outcomes such as HbA1c, while the Study characteristics section mentions hospitals only as intervention settings; searches for admissions, hospitalization, deaths, and all-cause mortality found no evidence that the review establishes reductions in either claimed outcome. (LLM, conf=0.77)

    Experimental — accuracy not yet measured

  • Person-centred care facilitates shared control and decision-making within the context of person priorities and goals.

    “Person-centred care is recommended to facilitate shared control and decision-making within the context of person priorities and goals.”

    From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [823]

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Research works printed but not linked: 56

  1. [13]13. Higgins JP, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions. Chichester: Wiley, 2008.
  2. [14]14. The Cochrane Collaboration. Review Manager (RevMan). Copenhagen: The Nordic Cochrane Centre, 2014.
  3. [17]17. Dalmau Llorca MR, Garcia Bernal G, Aguilar Martin C, Palau Galindo A. [Group versus individual education for type-2 diabetes patients]. Aten primaria 2003; 32: 36- 41.
  4. [19]19. Miselli V, Monzali E, Accorsi P, Bedogni C, Pagliani U, Zappavigna A et al. [Group care intervention on patients with Type 2 diabetes]. G It Diabetol Metab 2009; 29: 189-196.
  5. [20]20. Gallotti C, Rovelli R, Moraca R, Pellegrino C, Pacileo G, Tenconi MT. [Self help and mutual aid groups: effectiveness in Type 2 diabetes]. G It Diabetol Metab 2003; 23: 69-76.
  6. [21]21. Pennings-Van der Eerden L, Ripken T, Van Heijst P, Schrijvers A. Evaluation of the impact of a patient education programme for NIDDM patients on knowledge, self-care behaviour, metabolic control and lipid profiles. Gedrag Gezondheid 1991; 19: 246- 260.
  7. [41]41. Funk SG, Tornquist EM, Leeman J, Miles MS, Harrell JS, editors. Key Aspects of Preventing and Managing Chronic Illness. New York: Springer, 2001.
  8. [48]48. Hornsten A, Stenlund H, Lundman B, Sandstrom H. Improvements in HbA 1c remain after 5 years -a follow up of an educational intervention focusing on patients' personal understandings of Type 2 diabetes. Diabetes Res Clin Pract 2008; 81: 50-55.
  9. [49]49. Adolfsson ET, Walker-Engström ML, Smide B, Wikblad K. Patient education in type 2 diabetes-A randomized controlled 1-year follow-up study. Diabetes Res Clin Pract. 2007;76(3):341-50.
  10. [50]50. Brown S, Garcia A, Kouzekanani K, Hanis CL. Culturally competent diabetes self- management education for Mexican-Americans: the Starr County Border Health Initiative. Diabetes Care. 2002;25(2):259-68.
  11. [51]51. Cade JE, Kirk SF, Nelson P, Hollins L, Deakin T, Greenwood DC, Harvey EL. Can peer educators influence healthy eating in people with diabetes? Results of a randomized controlled trial. Diabet Med. 2009;26(10):1048-54.
  12. [52]52. Cheyette C. Weight no more: A randomised controlled trial for people with type 2 diabetes on insulin therapy. Practical Diabetes International. 2007; 24(9):450-6.
  13. [54]54. Cohen LB, Taveira TH, Khatana SA, Dooley AG, Pirraglia PA, Wu WC. Pharmacist- led shared medical appointments for multiple cardiovascular risk reduction in patients with type 2 diabetes. Diabetes Educ. 2011;37(6):801-12.
  14. [55]55. Dalmau Llorca MR, Garcia Bernal G, Aguilar Martin C, Palau Galindo A. [Group versus individual education for type-2 diabetes patients]. Atencion primaria / Sociedad Espanola de Medicina de Familia y Comunitaria. 2003;32(1):36-41.
  15. [56]56. Davies M, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, Dallosso HM, Daly H, Doherty Y, Eaton S, Fox C. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomized controlled trial. BMJ. 2008;336:491.
  16. [58]58. Deakin T, Cade J, Williams, Greenwood DC. Structured patient education: the Diabetes X-PERT Programme makes a difference. Diabet Med. 2006;23:944-54.
  17. [59]59. Delahanty LM, Dalton KM, Porneala B, Chang Y, Goldman VM, Levy D, Nathan DM, Wexler DJ. Improving diabetes outcomes through lifestyle change -A randomized controlled trial. Obesity. 2015;23(9):1792-9.
  18. [60]60. Domenech MI, Assad D, Mazzei ME, Kronsbein P, Gagliardino JJ. Evaluation of the effectiveness of an ambulatory teaching/treatment programme for non-insulin dependent (type 2) diabetic patients. Acta diabetologica. 1995;32(3):143-7.
  19. [61]61. Edelman D, Fredrickson SK, Melnyk SD, Coffman CJ, Jeffreys AS, Datta S, Jackson GL, Harris AC, Hamilton NS, Stewart H, Stein J. Medical clinics versus usual care for patients with both diabetes and hypertension: a randomized trial. Ann Intern Med. 2010;152(11):689-96.
  20. [62]62. Forjuoh SN, Ory MG, Jiang L, Vuong AM, Bolin JN. Impact of chronic disease self- management programs on type 2 diabetes management in primary care. World J Diabetes. 2014;5(3):407-14.
  21. [63]63. Gagliardino JJ, Lapertosa S, Pfirter G, Villagra M, Caporale JE, Gonzalez CD, Elgart J, Gonzalez L, Cernadas C, Rucci E, Clark C. Clinical, metabolic and psychological outcomes and treatment costs of a prospective randomized trial based on different educational strategies to improve diabetes care (PRODIACOR). Diabet Med. 2013;30(9):1102-11.
  22. [64]64. Gallotti C, Rovelli R, Moraca R, Pellegrino C, Pacileo G, Tenconi MT. Self help and mutual aid groups: Effectiveness in type 2 diabetes. [Italian]. Giornale Italiano di Diabetologia e Metabolismo [Internet]. 2003; 23(2):69-76.
  23. [65]65. Heller SR, Clarke P, Daly H, Davis I, McCulloch DK, Allison SP, Tattersall RB. Group education for obese patients with type 2 diabetes: greater success at less cost. Diabet Med. 1988;5(6):552-6.
  24. [68]68. Huisman S, de Gucht V, Maes S, Schroevers M, Chatrou M, Haak H. Self-regulation and weight reduction in patients with type 2 diabetes: a pilot intervention study. Patient Educ Couns. 2009;75(1):84-90.
  25. [69]69. Kattelmann K, Conti, K, Ren, C. The Medicine Wheel Nutrition Intervention: A Diabetes Education study with the Cheyenne River Sioux Tribe. J Am Diet Assoc. 2009;109(9):1532-9.
  26. [70]70. Kronsbein P, Jorgens V, Muhlhauser I, Scholz V, Venhaus A, Berger M. Evaluation of a structured treatment and teaching programme on non-insulin-dependent diabetes. Lancet. 1988;2(8625):1407-11.
  27. [71]71. Lorig K, Ritter P, Villa FJ, Armas J. Community-based peer-led diabetes self management: A randomized trial. Diabetes Educ. 2009;35:641-52.
  28. [72]72. Lozano ML, Armale MJ, Tena Domingo I, Sanchez Nebra C. [The education of type-2 diabetics: why not in groups?]. Atencion primaria / Sociedad Espanola de Medicina de Familia y Comunitaria. 1999;23(8):485-92.
  29. [73]73. McKibbin A, Golshan, S, Griver, K, Kitchen, K, Wykes, T. A healthy lifestyle intervention for middle-aged and older schizophrenia patients with diabetes mellitus: a 6- month follow-up analysis. Schizophr Res. 2010;121(0):1-8.
  30. [74]74. Miselli V, Monzali E, Accorsi P, Bedogni C, Pagliani U, Zappavigna A, Dotti C, Ferraioli AM, Rossi C, Valenti S, Trento M, Porta M. Group Care intervention on patients with type 2 diabetes. Giornale Italiano di Diabetologia e Metabolismo. 2009;29(4):189-96.
  31. [75]75. Mohamed H, Al-Lenjawi B, Amuna P, Zotor F, Elmahdi H. Culturally sensitive patient-centred educational programme for self-management of type 2 diabetes: a randomized controlled trial. Prim Care Diabetes. 2013;7(3):199-206.
  32. [77]77. Penckofer SM, Ferrans C, Mumby P, Byrn M, Emanuele MA, Harrison PR, Durazo- Arvizu RA, Lustman P. A psychoeducational intervention (SWEEP) for depressed women with diabetes. Ann Behav Med. 2012;44(2):192-206.
  33. [78]78. Pennings-Van der Eerden L, Ripken T, Van Heijst P, Schrijvers A. Evaluation of the impact of a patient education programme for NIDDM patients on knowledge, self-care behaviour, metabolic control and lipid profiles. Gedrag & Gezondheid: Tijdschrift voor Psychologie en Gezondheid. 1991;19(5):246-60.
  34. [79]79. Philis-Tsimikas A, Fortmann A, Lleva-Ocana L, Walker C, Gallo LC. Peer-led diabetes education programs in high-risk Mexican Americans improve glycemic control compared with standard approaches: a Project Dulce promotora randomized trial. Diabetes Care. 2011;34(9):1926-31.
  35. [80]80. Pieber TR, Holler A, Siebenhofer A, Brunner GA, Semlitsch B, Schattenberg S, Zapotoczky H, Rainer W, Krejs GJ. Evaluation of a structured teaching and treatment programme for type 2 diabetes in general practice in a rural area of Austria. Diabet Med. 1995;12(4):349-54.
  36. [81]81. Rickheim P, Weaver T, Flader JL, Kendall DM. Assessment of Group versus Individual Diabetes Education: A randomized study. Diabetes Care. 2002;25:269-74.
  37. [82]82. Ridgeway NA, Harvill DR, Harvill LM, Falin TM, Forester GM, Gose OD. Improved control of type 2 diabetes mellitus: a practical education/behavior modification program in a primary care clinic. South Med J. 1999;92(7):667-72.
  38. [83]83. Rosal M, Olendzski, B, and Reed, G. Diabetes self-management among low-income Spanish-speaking patients: a pilot study. Ann Behav Med. 2005;29(3):225-35.
  39. [84]84. Rosal MC, Ockene IS, Restrepo A, White MJ, Borg A, Olendzki B, Scavron J, Candib L, Welch G, Reed G. Randomized trial of a literacy-sensitive, culturally tailored diabetes self- management intervention for low-income latinos: latinos en control. Diabetes Care. 2011;34(4):838-44.
  40. [85]85. Sarkadi A, Rosenqvist U. Experience-based group education in Type 2 diabetes: a randomised controlled trial. Patient Educ Couns. 2004;53(3):291-8.
  41. [86]86. Scain SF, Friedman R, Gross JL. A structured educational program improves metabolic control in patients with type 2 diabetes: a randomized controlled trial. Diabetes Educ. 2009;35(4):603-11.
  42. [87]87. Smith SM, Paul G, Kelly A, Whitford DL, O'Shea E, O'Dowd T. Peer support for patients with type 2 diabetes: cluster randomised controlled trial. BMJ. 2011;342:d715.
  43. [88]88. Sperl-Hillen J BS, Fernandes O, Von Worley A, Vazquez-Benitez G, Parker E, Hanson A, Lavin-Tompkins J, Glasrud P, Davis H, Adams K, Parsons W, Spain CV. Comparative effectiveness of patient education methods for type 2 diabetes: a randomized controlled trial. Arch Intern Med. 2011;171(22):2001-10.
  44. [89]89. Sperl-Hillen J, Beaton S, Fernandes O, Von Worley A, Vazquez-Benitez G, Hanson A, Lavin-Tompkins J, Parsons W, Adams K, Spain CV. Are benefits from diabetes self- management education sustained? Am J Manag Care. 2013;19(2):104-12.
  45. [90]90. Toobert DJ, Glasgow RE, Strycker LA, Barrera M, Radcliffe JL, Wander RC, Bagdade JD. Biologic and quality-of-life outcomes from the Mediterranean Lifestyle Program: a randomized clinical trial. Diabetes Care. 2003;26(8):2288-93.
  46. [91]91. Toobert DJ, Strycker LA, Barrera M, Osuna D, King DK, Glasgow RE. Outcomes from a multiple risk factor diabetes self-management trial for Latinas: Viva bien! Ann Behav Med. 2011;41(3):310-23.
  47. [92]92. Toobert DJ, Strycker LA, King DK, Barrera M, Jr., Osuna D, Glasgow RE. Long-term outcomes from a multiple-risk-factor diabetes trial for Latinas: Viva Bien! Transl Behav Med. 2011;1(3):416-26.
  48. [93]93. Torres Hde C, Franco LJ, Stradioto MA, Hortale VA, Schall VT. [Evaluation of group and individual strategies in a diabetes education program]. Revista de saude publica. 2009;43(2):291-8.
  49. [94]94. Trento M, Passera P, Bajardi M, Tomalino M, Grassi G, Borgo E, Donnola C, Cavallo F, Bondonio P, Porta M. Lifestyle intervention by group care prevents deterioration of Type II diabetes: a 4-year randomized controlled clinical trial. Diabetologia. 2002;45(9):1231-9.
  50. [95]95. Trento M, Passera P, Borgo E, Tomalino M, Bajardi M, Cavallo F, Porta M. A 5-year randomized controlled study of learning, problem solving ability, and quality of life modifications in people with type 2 diabetes managed by group care. Diabetes Care. 2004;27(3):670-5.
  51. [96]96. Trento M, Passera P, Tomalino M, Bajardi M, Pomero F, Allione A, Vaccari P, Molinatti GM, Porta M. Group visits improve metabolic control in type 2 diabetes: a 2-year follow-up. Diabetes Care. 2001;24(6):995-1000.
  52. [97]97. Trento M, Basile M, Borgo E, Grassi G, Scuntero P, Trinetta A, Cavallo F, Porta M. A randomised controlled clinical trial of nurse-, dietitian-and pedagogist-led Group Care for the management of Type 2 diabetes. J Endocrinol Invest. 2008;31(11):1038-42.
  53. [98]98. Trento M, Gamba S, Gentile L, Grassi G, Miselli V, Morone G, Passera P, Tonutti L, Tomalino M, Bondonio P, Cavallo F. Rethink Organization to iMprove Education and Outcomes (ROMEO): a multicenter randomized trial of lifestyle intervention by group care to manage type 2 diabetes. Diabetes Care. 2010;33(4):745-7.
  54. [99]99. Vadstrup ES, Frolich A, Perrild H, Borg E, Roder M. Effect of a group-based rehabilitation programme on glycaemic control and cardiovascular risk factors in type 2 diabetes patients: the Copenhagen Type 2 Diabetes Rehabilitation Project. Patient Educ Couns. 2011;84(2):185-90.
  55. [100]100. Yoo JS, Lee SJ, Lee HC, Kim MJ. The effect of a comprehensive lifestyle modification program on glycemic control and body composition in patients with type 2 diabetes. Asian Nurs Res (Korean Soc Nurs Sci). 2007;1(2):106-15.
  56. [101]101. Zapotoczky H, Semlitsch, B, Herzog, G, Bahadori, B, Siebenhofer, A, Pieber, T and Zapotoczky HG. A controlled study of weight reduction in type 2 diabetics treated by two reinforcers. Int J Behav Med. 2001;8(1):42-9.

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Authors
Odgers‐Jewell, K., Ball, L. E., Kelly, J. T., Isenring, E. A., Reidlinger, D. P., & Thomas, R.
Affiliations
  • Bond University (AU)
  • Griffith University (AU)
Corresponding author
Odgers‐Jewell, K.
ORCID
Venue
Diabetic Medicine
Publisher
Wiley
Published
2017-03-20
Volume
34
Issue
8
Pages
1027-1039
ISSN
  • 0742-3071 (ISSN-L)
  • 1464-5491
DOI
10.1111/dme.13340
OpenAlex
W2589414328
Cited by
224
References
39
Citations by year
2026: 15 · 2025: 22 · 2024: 21 · 2023: 21 · 2022: 37 · 2021: 29 · 2020: 31 · 2019: 26 · 2018: 13 · 2017: 9
FWCI
3.15
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Bond University Research Portal (Bond University) (submittedVersion, other-oa)
  • Griffith Research Online (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
type 2 diabetes, patient education, HbA1c, fasting blood glucose, peer-led intervention, multidisciplinary team, diabetes knowledge, self-efficacy, blood pressure, serum lipids, peer supporters, usual care comparison, diabetes self-management
MeSH terms
Body Weight Maintenance, Healthy Lifestyle, Psychosocial Support Systems, Self-Management, Combined Modality Therapy, Diabetes Mellitus, Type 2, Group Structure, Glycated Hemoglobin, Humans, Hyperglycemia, Middle Aged, Patient Care Team, Patient Education as Topic, Peer Group, Weight Loss, Randomized Controlled Trials as Topic, Controlled Clinical Trials as Topic, Evidence-Based Medicine, Overweight

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