title: Effectiveness of Interactive Self-Management Interventions in Individuals With Poorly Controlled Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  To identify, assess, and summarize available scientific evidence on the effectiveness of interactive self-management interventions on glycemic control and patient-centered outcomes in individuals with poorly controlled type 2 diabetes.
  
  
  METHODS
  Major English and Chinese electronic databases including Medline, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and WanFang Data were searched to identify randomized controlled trials that reported the effectiveness of interactive self-management interventions in individuals with poorly controlled type 2 diabetes (glycated hemoglobin [HbA1c] ≥ 7.5% or 58 mmol/mol), from inception to June 2015. Data extraction and risk-of-bias assessment were performed by two reviewers independently. Meta-analysis was performed using Review Manager 5.3.
  
  
  RESULTS
  A total of 16 trials with 3,545 participants were included in the meta-analysis. Interactive self-management interventions could have a beneficial effect in individuals with poorly controlled type 2 diabetes in reducing HbA1c (mean difference: -0.43%, 95% CI: -0.67% to -0.18%), improving diabetes knowledge (standardized mean difference [SMD]: 0.30, 95% CI: 0.03 to 0.58), enhancing self-efficacy (SMD: 0.29, 95% CI: 0.14 to 0.44), and reducing diabetes-related distress (SMD: -0.21, 95% CI: -0.39 to -0.04). Self-management interventions supported with theory and structured curriculum showed desirable results in glycemic control. The behavioral change techniques, including providing feedback on performance, problem-solving, and action planning, were associated with a significant reduction in HbA1c.
  
  
  CONCLUSIONS
  Individuals with poorly controlled type 2 diabetes could benefit from interactive self-management interventions. Interventions targeting patients with poorly controlled diabetes, those who are at the greatest risk of developing complications, should be prioritized. Our findings indicate that providing feedback on performance, problem-solving, and action planning are promising behavioral change techniques specifically for individuals with poor glycemic control.
authors.affiliation: Postdoctoral Fellow, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
authors.forename: Li
authors.initials: L
authors.lastname: Cheng
authors.affiliation: Associate Professor, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
authors.forename: Janet W H
authors.initials: JW
authors.lastname: Sit
authors.affiliation: Senior Research Fellow, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
authors.forename: Kai-Chow
authors.initials: KC
authors.lastname: Choi
authors.affiliation: Professor, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
authors.forename: Sek-Ying
authors.initials: SY
authors.lastname: Chair
authors.affiliation: Professor, The School of Nursing, The Xi'an Jiaotong University, Xi'an, China.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Li
authors.affiliation: Student, The School of Nursing, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Xiao-le
authors.initials: XL
authors.lastname: He
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D006801:Humans; D011788:Quality of Life / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000592:standards*; D020377:Self Efficacy; D013663:Teaching / Q000592:standards
keywords: interactive; intervention; meta-analysis; poor control; self-management; type 2 diabetes