title: Behavioral Programs for Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Whether behavioral approaches for self-management programs benefit individuals with type 1 diabetes mellitus is unclear.
  
  
  OBJECTIVE
  To determine the effects of behavioral programs for patients with type 1 diabetes on behavioral, clinical, and health outcomes and to investigate factors that might moderate effect.
  
  
  METHODS
  6 electronic databases (1993 to June 2015), trial registries and conference proceedings (2011 to 2014), and reference lists.
  
  
  METHODS
  36 prospective, controlled studies involving participants of any age group that compared behavioral programs with usual care, active controls, or other programs.
  
  
  METHODS
  One reviewer extracted and another verified data. Two reviewers assessed quality and strength of evidence (SOE).
  
  
  RESULTS
  Moderate SOE showed reduction in glycated hemoglobin (HbA1c) at 6 months after the intervention compared with usual care (mean difference, -0.29 [95% CI, -0.45 to -0.13] percentage points) and compared with active controls (-0.44 [CI, -0.69 to -0.19] percentage points). At the end of the intervention and 12-month follow-up or longer, there were no statistically significant differences in HbA1c (low SOE) for comparisons with usual care or active control. Compared with usual care, generic quality of life at program completion did not differ (moderate SOE). Other outcomes had low or insufficient SOE. Adults appeared to benefit more for glycemic control at program completion (-0.28 [CI, -0.57 to 0.01] percentage points) than did youth (-0.12 [CI, -0.43 to 0.19] percentage points). Program intensity appeared not to influence effectiveness; some individual delivery appears beneficial.
  
  
  CONCLUSIONS
  All studies had medium or high risk of bias. There was scarce evidence for many outcomes.
  
  
  CONCLUSIONS
  Behavioral programs for type 1 diabetes offer some benefit for glycemic control, at least at short-term follow-up, but improvement for other outcomes has not been shown. (PROSPERO registration number: CRD42014010515).
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality. (PROSPERD registration number: CRD42014010515).
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pillay
authors.forename: Marni J
authors.initials: MJ
authors.lastname: Armstrong
authors.forename: Sonia
authors.initials: S
authors.lastname: Butalia
authors.forename: Lois E
authors.initials: LE
authors.lastname: Donovan
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Sigal
authors.forename: Pritam
authors.initials: P
authors.lastname: Chordiya
authors.forename: Sanjaya
authors.initials: S
authors.lastname: Dhakal
authors.forename: Ben
authors.initials: B
authors.lastname: Vandermeer
authors.forename: Lisa
authors.initials: L
authors.lastname: Hartling
authors.forename: Megan
authors.initials: M
authors.lastname: Nuspl
authors.forename: Robin
authors.initials: R
authors.lastname: Featherstone
authors.forename: Donna M
authors.initials: DM
authors.lastname: Dryden
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology* / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D010353:Patient Education as Topic; D011788:Quality of Life; D012648:Self Care
chemical_list: D006442:Glycated Hemoglobin