title: Effectiveness of group-based self-management education for individuals with Type 2 diabetes: a systematic review with meta-analyses and meta-regression.
abstract: Patient education for the management of Type 2 diabetes can be delivered in various forms, with the goal of promoting and supporting positive self-management behaviours. This systematic review aimed to determine the effectiveness of group-based interventions compared with individual interventions or usual care for improving clinical, lifestyle and psychosocial outcomes in people with Type 2 diabetes.
  
  
  
  Six electronic databases were searched. Group-based education programmes for adults with Type 2 diabetes that measured glycated haemoglobin (HbA1c) and followed participants for ≥ 6 months were included. The primary outcome was HbA1c, and secondary outcomes included fasting blood glucose, weight, body mass index, waist circumference, blood pressure, blood lipid profiles, diabetes knowledge and self-efficacy.
  
  
  
  Fifty-three publications describing 47 studies were included (n = 8533 participants). Greater reductions in HbA1coccurred in group-based education compared with controls at 6-10 months [n = 30 studies; mean difference (MD) = 3 mmol/mol (0.3%); 95% confidence interval (CI): -0.48, -0.15; P = 0.0002], 12-14 months [n = 27 studies; MD = 4 mmol/mol (0.3%); 95% CI: -0.49, -0.17; P < 0.0001], 18 months [n = 3 studies; MD = 8 mmol/mol (0.7%); 95% CI: -1.26, -0.18; P = 0.009] and 36-48 months [n = 5 studies; MD = 10 mmol/mol (0.9%); 95% CI: -1.52, -0.34; P = 0.002], but not at 24 months. Outcomes also favoured group-based education for fasting blood glucose, body weight, waist circumference, triglyceride levels and diabetes knowledge, but not at all time points. Interventions facilitated by a single discipline, multidisciplinary teams or health professionals with peer supporters resulted in improved outcomes in HbA1cwhen compared with peer-led interventions.
  
  
  
  Group-based education interventions are more effective than usual care, waiting list control and individual education at improving clinical, lifestyle and psychosocial outcomes in people with Type 2 diabetes.
authors.affiliation: Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
authors.forename: K
authors.identifier: 0000-0002-1453-4447
authors.initials: K
authors.lastname: Odgers-Jewell
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
authors.forename: L E
authors.initials: LE
authors.lastname: Ball
authors.affiliation: Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
authors.forename: J T
authors.initials: JT
authors.lastname: Kelly
authors.affiliation: Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
authors.forename: E A
authors.initials: EA
authors.lastname: Isenring
authors.affiliation: Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
authors.forename: D P
authors.initials: DP
authors.lastname: Reidlinger
authors.affiliation: Centre for Research in Evidence-Based Practice (CREBP), Bond University, Gold Coast, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Thomas
mesh_terms: D000068959:Body Weight Maintenance; D003131:Combined Modality Therapy; D018849:Controlled Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000628:therapy*; D019317:Evidence-Based Medicine; D006442:Glycated Hemoglobin / Q000032:analysis; D006127:Group Structure; D000070497:Healthy Lifestyle; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D008875:Middle Aged; D050177:Overweight / Q000150:complications / Q000517:prevention & control / Q000628:therapy; D010348:Patient Care Team; D010353:Patient Education as Topic; D010379:Peer Group; D000072858:Psychosocial Support Systems; D016032:Randomized Controlled Trials as Topic; D000073278:Self-Management / Q000193:education*; D015431:Weight Loss
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human