Diabetes self-management education and support for adults with newly diagnosed type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials

Highlights

• DSMES for newly diagnosed T2DM might affect patient-centered outcomes.

• The glycemic control significantly improved vs usual care.

• Psychosocial and behavioral effects are inconclusive.

• Further studies with higher precision using standardized measurements are required.

Abstract

This systematic review aimed to identify the effectiveness of diabetes self-management education and support (DSMES) among adults within 12 months of diagnosis of type 2 diabetes mellitus (T2DM). We searched the Cochrane Library, MEDLINE, CINAHL, PsycINFO, ERIC, and other sources up to March 2019 to detect randomized controlled trials in the last decade based on the global guidelines’ definition of DSMES. Data were categorized into biomedical, psychosocial, and behavioral outcomes and synthesized using a random-effects model. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. We scrutinized 12 studies that enrolled 2,386 adults with newly diagnosed T2DM. Biomedical outcomes presented the pooled effects of HbA1c −0.21% (95% confidence interval, −0.38, −0.04), body weight −2.36 kg (−5.77, 1.05), and waist circumference −1.8 cm (−5.63, 2.04) when the data from the two studies with low risk of bias were combined (N = 1,082). Psychosocial and behavioral effects were inconclusive owing to mixed results from various scales and reporting. The quality of the body of evidence was low. DSMES within 12 months of T2DM diagnosis might affect patient-centered outcomes. Further studies with higher precision using standardized measurement methods are required.

Introduction

The number of adults with type 2 diabetes mellitus (T2DM) has been increasing worldwide. This number is estimated to exceed 600 million by 2040 [1], [2]. In many cases, T2DM progresses asymptomatically. Approximately half of those diagnosed with T2DM have developed one or more diabetes complications at the time of diagnosis [2].

To control T2DM and its complications, the international and national guidelines recommend that diabetes self-management education and support (DSMES) be provided to people with T2DM around the time of diagnosis [3], [4], [5], [6]. According to the guidelines, DSMES is defined as “the ongoing process of facilitating the knowledge, skills, and abilities necessary for diabetes self-care as well as providing ongoing support to sustain the self-management gains made by patients as a result of education” [3], [4], [5].

Previous systematic reviews and meta-analyses have reported that educational interventions for people with T2DM improved their glycemic control, weight loss, diabetes knowledge, self-efficacy, quality of life, dietary behavior, physical activity, and smoking cessation [7], [8], [9], [10], [11], [12], [13]. However, there is no integrated evidence on the effectiveness of DSMES specifically among people with newly diagnosed T2DM.

Revealing whether DSMES is effective in patients with newly diagnosed T2DM can contribute to more feasible disease control from the time of diagnosis. Therefore, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that measured the effectiveness of DSMES in adults within 12 months of T2DM diagnosis on biomedical, psychosocial, and behavioral outcomes compared with the usual care.