An evaluation of the effectiveness of self-management interventions for people with type 2 diabetes after an acute coronary syndrome: a systematic review

${\bf Background:}$ Type 2 diabetes is highly prevalent in patients with acute coronary syndrome and impacts negatively on health outcome s and self-management. Both conditions shar e similar risk factor s. However, there is insufficient evidence on the effectiveness of combined interventions to promote self-management behaviour for people who with diabetes and cardiac problems. Identifying critical features of successful interventions will inform future integrated self-management programmes for patients with both conditions. ${\bf Objectives:}$ To assess the evidence on the effectiveness of existing interventions to promote self-management behaviour for patients presenting with acute coronary syndrome and type 2 diabetes in secondary care settings and post discharge . ${\bf Design:}$ We searched Medline, PubMed, CINAHL Plus, PsycInfo, Cochrane Library and AMED for randomised controlled trials published between January 2005 and December 2014. The search was performed using the following search terms of “acute coronary syndrome”, “type 2 diabetes” and “self-management intervention” and their substitutes combined . ${\bf Results:}$ Out of 4275 articles that were retrieved, only 4 trials met all the inclusion criteria (population, intervention, comparison and outcome) and were analysed. Overall, the results show that providing combined interventions for patients with both conditions including educational sessions supported by multimedia or telecommunication technologies were partially successful in promoting self-management behaviours. Implementation of these combined interventions during patient’s hospitalisation and post discharge was feasible. Intervention group subjects, reported a significant improvement in self-efficacy, level of knowledge, glycated haemoglobin, blood pressure and fasting glucose test. However, there are many threats have been noticed around internal validity of included studies that could compromise the conclusions drawn . ${\bf Conclusion:}$ With limited research in this area there was no final evidence to support effectiveness of combined intervention s to promote self-management behaviour for patient s with type 2 diabetes and acute coronary syndrome. Sufficiently powered, good quality, well conducted and reported randomised controlled trials are required.This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1111/jocn.1348