A systematic review included 36 randomized control trials that assessed the impact of structured education on glucose control and hypoglycaemia. Majority of the studies included a predominant Caucasian population. There was heterogeneity in the included studies such as intervention methods and intensity as well as follow up periods. Group based education was preferred over individual education by most studies. Overall, most of the studies showed a significant positive effect on glycaemic control compared with control groups. One study showed a significant impact of structured education on hypoglycaemia.
A systematic review including 72 studies was abstracted in DARE. Studies with short follow-up (less than 6 months) demonstrated positive effects of self-management training on knowledge, frequency and accuracy of self-monitoring of blood glucose, self-reported dietary habits, and glycemic control. The effects of interventions on lipids, physical activity, weight and blood-pressure (cardiovascular risk factors) 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 analysis included indirect costs; and few studies examined health care utilisation. Performance, selection, attrition, and detection bias were common in the studies reviewed, and external generalisability was often limited.
A systematic review including at least 20 studies was abstracted in DARE. Self-management programmes showed an approximate 0.81% reduction in haemoglobin A1c levels compared with control; the ES was -0.36, (95% CI: -0.52 to -0.21) based on 20 studies. Fasting blood outcomes were also improved; the ES was -0.28, (95% CI: -0.47 to -0.08) based on 13 studies, equivalent to a reduction in blood glucose level of 0.95 mmol/L (17 mg/dL). There was no statistically significant difference in weight change between the treatment and control groups (14 studies; ES -0.04, 95% CI: -0.16 to 0.07). The 3 studies that focused primarily on diet and education had a pooled ES for haemoglobin A1c that was almost twice as great as the pooled ES for the remaining 9 studies; however, this difference was not significant. There was some heterogeneity in results and a possibility of publication bias.
Comment: The quality of evidence is downgraded by heterogeneity and possibility of publication bias.