Location of Repository

The clinical effectiveness of diabetes education models for Type 2 diabetes: a systematic review

By E. Loveman, G.K. Frampton and A.J. Clegg


Objective: To examine the clinical effectiveness of patient education models for adults with Type 2 diabetes.<br/><br/>Data sources: Electronic databases were searched from 2002 to January 2007.<br/><br/>Review methods: A systematic review of the literature on educational interventions in diabetes was undertaken. This was an update of a previous systematic review.<br/><br/>Results: Including studies identified in the previous systematic review, there were 13 published studies. Eight studies of education on multiple aspects of diabetes self-management were identified that provided education that was focused on a particular aspect of self-management. The quality of reporting and methodology of the studies was variable. Studies of multi-component educational interventions yielded mixed results. Some trials reported significant improvements on measures of diabetic control but others did not. Positive effects may be attributable to longer-term interventions with a shorter duration between the end of the intervention and the follow-up evaluation point. There may also be an effect of having a multi-professional team delivering the educational programme. Studies of focused educational interventions did not yield consistent results. Some effects were shown on measures of diabetic control in studies that focused on diet or exercise alone. Although the effects shown were generally small, those that were present did appear to be relatively long-lasting. This update review does not substantially alter the conclusions of the previous systematic review; for each outcome, the proportion of studies that demonstrated significant effects of education was similar.<br/><br/>Conclusions: Based on the evidence, it would seem that education delivered by a team of educators, with some degree of reinforcement of that education made at additional points of contact, may provide the best opportunity for improvements in patient outcomes. Educators need to have time and resources to fulfil the needs of any structured educational programme. There is also a need for education to have a clear programme at the outset. From the evidence reported it is unclear what resources would need to be directed at the educators themselves to ensure that they can deliver programmes successfully. Any future research should consider patient education within the context of overall diabetes care and as such follow guidelines for the development and evaluation of complex interventions. Good-quality, longer-term studies would be desirable, but these would require careful consideration around the nature of any control group. Information is needed to clarify the sensitivity of diabetes education programmes to the performance of the diabetes educators, in order to ensure success and cost-effectiveness of education programmes.<br/><br/

Topics: R1, RZ
Year: 2008
OAI identifier: oai:eprints.soton.ac.uk:72883
Provided by: e-Prints Soton
Download PDF:
Sorry, we are unable to provide the full text but you may find it at the following location(s):
  • http://dx.doi.org/10.3310/hta1... (external link)
  • Suggested articles


    1. (2001). 1 Clinical and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer’s disease: a rapid and systematic
    2. (2006). 1 MeSH descriptor Diabetes Mellitus, Type 2 explode all trees #2 ((typ* 2 or type ii or type two)
    3. A church-based diabetes self-management education program for African Americans with type 2 diabetes. Preventing Chronic Disease 2006;3(3):1–16. Trials excluded owing to outcomes (i.e. no reports of diabetic control,
    4. A controlled trial of the effectiveness of a diabetes education programme in a multi-ethnic community in Glasgow. doi
    5. A randomized trial comparing intensive and passive education in patients with diabetes mellitus. doi
    6. A randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes. doi
    7. (2000). A review by
    8. (2002). A study of the methods used to select review criteria for clinical audit. By Hearnshaw
    9. (2008). A systematic review and economic model of switching from nonglycopeptide to glycopeptide antibiotic prophylaxis for surgery.
    10. (2003). A systematic review of psychosocial outcomes following education, selfmanagement and psychological interventions in diabetes mellitus. Patient Educ Couns doi
    11. (2008). All rights reserved.No. 19 Clinical effectiveness and costeffectiveness of growth hormone in adults in relation to impact on quality of life: a systematic review and economic
    12. (2008). All rights reserved.No. 2 ‘Cut down to quit’ with nicotine replacement therapies in smoking cessation: a systematic review of effectiveness and economic analysis. By Wang doi
    13. (2008). All rights reserved.No. 34 A systematic review of comparisons of effect sizes derived from randomised and non-randomised studies. By MacLehose
    14. (2008). All rights reserved.No. 39 Systematic review of isolation policies in the hospital management of methicillinresistant Staphylococcus aureus: a review of the literature with epidemiological and economic modelling. By Cooper BS, doi
    15. (2008). All rights reserved.No. 4 A systematic review of the effectiveness and cost-effectiveness of neuroimaging assessments used to visualise the seizure focus in people with refractory epilepsy being considered for surgery. By Whiting doi
    16. (2008). All rights reserved.No. 5 A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines. By doi
    17. (2008). All rights reserved.Volume 9,
    18. (2008). Assessment reports published to date 132Health Technology Assessment
    19. authors would like to know your views about this report.
    20. (2008). b The value for the intervention only (not the control) is indicated by the authors to be a geometric mean.Health Technology Assessment
    21. (2008). colleagues69 used the Life Skills cognitive knowledge of diabetes test provided by the Diabetes Education Society and approved by the American Diabetes Association. Appendix 7 116Health Technology Assessment
    22. (2004). Comparative analysis of conventional and an adaptive computer-based hypoglycaemia education programs. Patient Educ Couns doi
    23. Cost and benefits of a multidisciplinary intensive diabetes education programme. doi
    24. Diabetes education and care management significantly improve patient outcomes in the dialysis unit. doi
    25. Diabetes patient education: a meta-analysis and meta-regression. doi
    26. (2004). Dietary advice for treatment of type 2 diabetes mellitus in adults. Cochrane Database Syst Rev doi
    27. (2004). Education and quality of life in diabetic patients. Patient Educ Couns 2004; 53:285–90. Trials excluded owing to the nature of the educational intervention (i.e. not an educational programme, insufficient details provided or not reproducible) Acik
    28. (2003). Effect of structured group education on glycemic control and hypoglycemia in insulin-treated patients. Diabetes Care doi
    29. (2004). Effects of a structured health education programme by a diabetic education nurse on cardiovascular risk factors in Chinese Type 2 diabetic patients: a 1-year prospective randomized study. Diabet Med doi
    30. (2002). Effects of lifestyle modifications on patients with type 2 diabetes: the Japan Diabetes Complications Study (JDCS) study design, baseline analysis and three year-interim report. Horm Metab Res doi
    31. Evaluation of a theory-based nutrition intervention for older adults with diabetes mellitus. doi
    32. (2005). Group diabetes patient education. A model for use in a continuing care retirement community. J Gerontol Nurs 2003;29:37–44. Trials excluded owing to inappropriate patient populations (i.e. not adults with doi
    33. (2003). How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical
    34. (2005). Implementation and evaluation of a low-literacy diabetes education computer multimedia application. Diabetes Care doi
    35. (2008). Include education about intensifying treatment even though the effect may be due to the intensification – this can be discussed in the narrative.Health Technology Assessment
    36. insulin: total
    37. (1979). Intervention Participants Outcome design measures Outcomes Weight control group Glucose monitoring group Differences (n = 22) (n = 23) between groups
    38. (2008). Knowledge of diabetes was tested by Trento and colleagues53–55 using the GISED. This Health Technology Assessment
    39. (2005). Long-term non-pharmacological weight loss interventions for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev doi
    40. (2003). Meta-analysis of randomized educational and behavioral interventions in type 2 diabetes. Diabetes Educ doi
    41. (2008). Metabolic improvement after intervention focusing on personal understanding in type 2 diabetes. Diabetes Res Clin Pract doi
    42. No clear effect of diabetes education on glycaemic control for Turkish type 2 diabetes patients: a controlled experiment in general practice.
    43. (2007). No. 1 Pemetrexed disodium for the treatment of malignant pleural mesothelioma: a systematic review and economic evaluation. By Dundar
    44. (2006). No. 1 The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer’s disease. By Loveman E, doi
    45. (2005). Promoting glycemic control through diabetes self-management: evaluating a patient activation intervention. Patient Educ Couns 2005; 56:28–34. Trials excluded owing to the length of follow-up doi
    46. (2004). Teaching and motivating patients to control their risk factors retards progression of cardiovascular as well as microvascular sequelae of type 2 diabetes mellitus – a randomized prospective 8 years follow-up study. Diabet Med doi
    47. (2002). Teaching patients to monitor their risk factors retards the progression of vascular complications in high-risk patients with type 2 diabetes mellitus – a randomized prospective study. Diabet Med doi
    48. (2004). The New Zealand Diabetes Passport Study: a randomized controlled trial of the impact of a diabetes passport on risk factors for diabetes-related complications. Diabet Med doi
    49. The role of diabetes education in maintaining lifestyle changes.
    50. (2008). The website also provides information about the HTA Programme and lists the membership of the various committees. HTAThe clinical effectiveness of diabetes education models for Type 2 diabetes: a systematic review E Loveman,
    51. Validation of a counseling strategy to promote the adoption and the maintenance of physical activity by type 2 diabetic subjects. Diabetes Care 2003;26:404–8. Gabbay doi
    52. (2004). What is the best imaging strategy for acute stroke? By
    53. (2004). Who benefits most from diabetes education? Results of a randomized controlled trial. Diabetes
    54. (2004). Writing Committee. ROMEO: rethink organization to improve education and outcomes. Diabet Med doi

    To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.