Meta-analyses look at effects of behavioral programs for diabetes

More intensive behavioral programs were more effective at helping patients with type 2 diabetes lower their HbA1c levels but not those with type 1, according to systematic analyses recently published in Annals of Internal Medicine.

The benefits of behavioral programs for patients with type 1 or type 2 diabetes were analyzed by 2 systematic analyses published in Annals of Internal Medicine on Sept. 29.

The analysis of programs for type 2 diabetes included 132 randomized controlled trials comparing behavioral programs with usual care, active controls, or other behavioral programs. It found improvements in glycemic control (defined as at least a 0.4% reduction in HbA1c) with programs that offered both lifestyle and diabetes self-management education and support and typically involved more than 10 hours of patient contact. Self-management programs without added support provided little benefit, especially if they lasted 10 hours or less.

Programs delivered in person were more effective than ones that used only technology. Improvements in HbA1c seemed greater for participants who had a baseline HbA1c of at least 7%, were younger than 65, or were minorities. Both individual and group programs appeared beneficial, and the analysis was not able to determine if there is a difference in effectiveness between programs led by professional health care workers versus laypeople.

The analysis for type 1 diabetes programs included 35 prospective controlled studies comparing interventions to usual care, an active control, or another intervention. There was moderately strong evidence that a behavioral intervention reduced HbA1c in the subsequent 6 months. However, by a year, there was no significant difference. Quality of life did not appear to be improved, and the intensity of a program didn't seem to affect effectiveness. Adults did appear to benefit more than youth, the analysis found. The authors noted that the findings might underestimate the effects of the programs in the real world, because all participants had some extra contact due to their participation in a study. Behavioral programs should be evaluated while underway to make sure they are the right fit for the target population, the authors said.