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Cited by 1,846Diabetes Management and EducationDiabetes Management and ResearchDiabetes Treatment and Management

Effectiveness of Self-Management Training in Type 2 Diabetes

Open access
Norris, Susan L., Engelgau, Michael M., Venkat Narayan, K.M.·2001·Diabetes Care
DOI 10.2337/diacare.24.3.561
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Abstract

OBJECTIVE—To systematically review the effectiveness of self-management training in type 2 diabetes. RESEARCH DESIGN AND METHODS—MEDLINE, Educational Resources Information Center (ERIC), and Nursing and Allied Health databases were searched for English-language articles published between 1980 and 1999. Studies were original articles reporting the results of randomized controlled trials of the effectiveness of self-management training in people with type 2 diabetes. Relevant data on study design, population demographics, interventions, outcomes, methodological quality, and external validity were tabulated. Interventions were categorized based on educational focus (information, lifestyle behaviors, mechanical skills, and coping skills), and outcomes were classified as knowledge, attitudes, and self-care skills; lifestyle behaviors, psychological outcomes, and quality of life; glycemic control; cardiovascular disease risk factors; and economic measures and health service utilization. RESULTS—A total of 72 studies described in 84 articles were identified for this review. Positive effects of self-management training on knowledge, frequency and accuracy of self-monitoring of blood glucose, self-reported dietary habits, and glycemic control were demonstrated in studies with short follow-up (<6 months). Effects of interventions on lipids, physical activity, weight, and blood pressure were variable. With longer follow-up, interventions that used regular reinforcement throughout follow-up were sometimes effective in improving glycemic control. Educational interventions that involved patient collaboration may be more effective than didactic interventions in improving glycemic control, weight, and lipid profiles. No studies demonstrated the effectiveness of self-management training on cardiovascular disease–related events or mortality; no economic analyses included indirect costs; few studies examined health-care utilization. Performance, selection, attrition, and detection bias were common in studies reviewed, and external generalizability was often limited. CONCLUSIONS—Evidence supports the effectiveness of self-management training in type 2 diabetes, particularly in the short term. Further research is needed to assess the effectiveness of self-management interventions on sustained glycemic control, cardiovascular disease risk factors, and ultimately, microvascular and cardiovascular disease and quality of life.

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  • There is clear evidence that diabetes education improves patient outcomes.

    “However, there is clear evidence that diabetes education improves patient outcomes (97–99).”

    From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [98]

    The review’s Effectiveness of interventions section reports short-term improvements in knowledge, self-monitoring skills, dietary habits and glycemic control among people with type 2 diabetes. The claim omits those limits: the review also reports variable effects for other outcomes and less consistent benefits with longer follow-up. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • There is clear evidence that diabetes education improves patient outcomes.

    “However, there is clear evidence that diabetes education improves patient outcomes (97 -99).”

    From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [98]

  • Better outcomes were reported for DSME interventions that were longer and included follow-up support, that were tailored to individual needs and preferences, and that addressed psychosocial issues.

    “Better outcomes were reported for DSME interventions that were longer and included follow-up support (101), that were tailored to individual needs and preferences (100), and that addressed psychosocial issues (100,101,105).”

    From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [101]

  • DSME is an essential element of diabetes care, and National Standards for DSME are based on evidence for its benefits.

    “DSME is an essential element of diabetes care (100–106), and National Standards for DSME (107) are based on evidence for its benefits.”

    From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [101]

  • Several studies have found that DSME is associated with improved diabetes knowledge and improved self-care behavior, improved clinical outcomes such as lower A1C, lower self-reported weight, and improved quality of life.

    “Several studies have found that DSME is associated with improved diabetes knowledge and improved self-care behavior (101), improved clinical outcomes such as lower A1C (102,103,105,106,110), lower self-reported weight (101), and improved quality of life (104).”

    From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [101]

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Research works printed but not linked: 1

  1. [20]20. Clarke M, Oxman AD, Eds.: Cochrane Reviewers Handbook 4.1.1. In The Cochrane Library. Issue 4. Oxford, U.K., 2000

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Authors
Norris, S. L., Engelgau, M. M., & Venkat Narayan, K. M.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
ORCID
Norris, Susan L.
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2001-03-01
Volume
24
Issue
3
Pages
561-587
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.24.3.561
OpenAlex
W2148355987
Cited by
1,846
References
124
Citations by year
2026: 20 · 2025: 21 · 2024: 21 · 2023: 35 · 2022: 48 · 2021: 68 · 2020: 53 · 2019: 67 · 2018: 77 · 2017: 91 · 2016: 97 · 2015: 105 · 2014: 124 · 2013: 108 · 2012: 108
FWCI
7.19
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
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, self-management education, glycemic control, self-monitoring of blood glucose, patient education, lifestyle modification, patient collaboration, cardiovascular risk factors, quality of life, health care utilization, economic outcomes
MeSH terms
Adaptation, Psychological, Diabetes Mellitus, Type 2, Humans, Patient Education as Topic, Self Care, Randomized Controlled Trials as Topic, Databases, Bibliographic, MEDLINE

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