Group Based Training for Self-Management Strategies in People with Type 2 Diabetes Mellitus

A meta-analysis 2 included 47 studies (n = 8533). Greater reductions in HbA1c occurred in group-based education compared with controls (usual care, waiting list control and individual education) at 6-10 months (mean difference [MD] = 3 mmol/mol (0.3%); 95% CI -0.48 to -0.15; P = 0.0002; 30 trials ), 12-14 months (MD = 4 mmol/mol (0.3%); 95% CI -0.49 to -0.17; P < 0.0001; 27 trials), and 36-48 months (MD = 10 mmol/mol (0.9%); 95% CI -1.52 to -0.34; P = 0.002; 10 trials), but not at 24 months. Outcomes also favoured group-based education for fasting blood glucose, body weight, waist circumference, and triglyceride levels.

Another meta-analysis 3 assessing group based diabetes self-management education compared to routine treatment included 21 studies (n =2833). HbA1c was significantly reduced at 6 months (0.44% points; P=0.0006; 13 studies, n=1883), 12 months (0.46% points; P=0.001; 11 studies, n=1503) and 2 years (0.87% points; P<0.00001; 3 studies, n=397) and fasting blood glucose levels were also significantly reduced at 12 months. Self-management skills and empowerment/self-efficacy were improved.

A Cochrane review [Abstract] 1 [withdrawn from publication] included 14 studies with a total of 1532 subjects. The results of the meta-analyses in favour of group-based diabetes education programmes were reduced glycated haemoglobin at four to six months (1.4%; 95% confidence interval (CI) 0.8 to 1.9; P < 0.00001), at 12-14 months (0.8%; 95% CI 0.7 to 1.0; P < 0.00001) and two years (1.0%; 95% CI 0.5 to 1.4; P < 0.00001); reduced fasting blood glucose levels at 12 months (1.2 mmol/L; 95% CI 0.7 to 1.6; P < 0.00001); reduced body weight at 12-14 months (1.6 Kg; 95% CI 0.3 to 3.0; P = 0.02); improved diabetes knowledge at 12-14 months (SMD 1.0; 95% CI 0.7 to 1.2; P < 0.00001) and reduced systolic blood pressure at four to six months (5 mmHg: 95% CI 1 to 10; P = 0.01). There was also a reduced need for diabetes medication (odds ratio 11.8, 95% CI 5.2 to 26.9; P < 0.00001; RD = 0.2; NNT = 5). Therefore, for every five patients attending a group-based education programme we could expect one patient to reduce diabetes medication.

References

• Steinsbekk A, Rygg LØ, Lisulo M et al. WITHDRAWN: Group based diabetes self-management education compared to routine treatment, waiting list control or no intervention for people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2015;(6):CD003417. [PubMed]
• Odgers-Jewell K, Ball LE, Kelly JT et al. Effectiveness of group-based self-management education for individuals with Type 2 diabetes: a systematic review with meta-analyses and meta-regression. Diabet Med 2017;34(8):1027-1039. [PubMed]
• Steinsbekk A, Rygg LØ, Lisulo M et al. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res 2012;(12):213. [PubMed]