title: Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control.
abstract: OBJECTIVE
  To evaluate the efficacy of self-management education on GHb in adults with type 2 diabetes.
  
  
  METHODS
  We searched for English language trials in Medline (1980-1999), Cinahl (1982-1999), and the Educational Resources Information Center database (ERIC) (1980-1999), and we manually searched review articles, journals with highest topic relevance, and reference lists of included articles. Studies were included if they were randomized controlled trials that were published in the English language, tested the effect of self-management education on adults with type 2 diabetes, and reported extractable data on the effect of treatment on GHb. A total of 31 studies of 463 initially identified articles met selection criteria. We computed net change in GHb, stratified by follow-up interval, tested for trial heterogeneity, and calculated pooled effects sizes using random effects models. We examined the effect of baseline GHb, follow-up interval, and intervention characteristics on GHb.
  
  
  RESULTS
  On average, the intervention decreased GHb by 0.76% (95% CI 0.34-1.18) more than the control group at immediate follow-up; by 0.26% (0.21% increase - 0.73% decrease) at 1-3 months of follow-up; and by 0.26% (0.05-0.48) at > or = 4 months of follow-up. GHb decreased more with additional contact time between participant and educator; a decrease of 1% was noted for every additional 23.6 h (13.3-105.4) of contact.
  
  
  CONCLUSIONS
  Self-management education improves GHb levels at immediate follow-up, and increased contact time increases the effect. The benefit declines 1-3 months after the intervention ceases, however, suggesting that learned behaviors change over time. Further research is needed to develop interventions effective in maintaining long-term glycemic control.
authors.affiliation: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. scn5@cdc.gov
authors.forename: Susan L
authors.initials: SL
authors.lastname: Norris
authors.forename: Joseph
authors.initials: J
authors.lastname: Lau
authors.forename: S Jay
authors.initials: SJ
authors.lastname: Smith
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Schmid
authors.forename: Michael M
authors.initials: MM
authors.lastname: Engelgau
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology / Q000523:psychology*; D005006:Ethnicity; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000145:classification; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic; D012648:Self Care
chemical_list: D001786:Blood Glucose