dc.contributor.author | Captieux, M | en_US |
dc.contributor.author | Pearce, G | en_US |
dc.contributor.author | Parke, HL | en_US |
dc.contributor.author | Epiphaniou, E | en_US |
dc.contributor.author | Wild, S | en_US |
dc.contributor.author | Taylor, SJC | en_US |
dc.contributor.author | Pinnock, H | en_US |
dc.date.accessioned | 2018-11-22T12:15:03Z | |
dc.date.available | 2018-09-12 | en_US |
dc.date.issued | 2018-12-14 | en_US |
dc.date.submitted | 2018-11-09T22:24:53.221Z | |
dc.identifier.other | 10.1016/S0140-6736(17)32967-7 | |
dc.identifier.uri | http://qmro.qmul.ac.uk/xmlui/handle/123456789/52823 | |
dc.description.abstract | OBJECTIVES: Self-management support aims to give people with chronic disease confidence to actively manage their disease, in partnership with their healthcare provider. A meta-review can inform policy-makers and healthcare managers about the effectiveness of self-management support strategies for people with type 2 diabetes, and which interventions work best and for whom. DESIGN: A meta-review of systematic reviews of randomised controlled trials (RCTs) was performed adapting Cochrane methodology. SETTING AND PARTICIPANTS: Eight databases were searched for systematic reviews of RCTs from January 1993 to October 2016, with a pre-publication update in April 2017. Forward citation was performed on included reviews in Institute for Scientific Information (ISI) Proceedings. We extracted data and assessed quality with the Revised-Assessment of Multiple Systematic Reviews (R-AMSTAR). PRIMARY AND SECONDARY OUTCOME MEASURES: Glycaemic control as measured by glycated haemoglobin (HbA1c) was the primary outcome. Body mass Index, lipid profiles, blood pressure and quality of life scoring were secondary outcomes. Meta-analyses reporting HbA1c were summarised in meta-forest plots; other outcomes were synthesised narratively. RESULTS: 41 systematic reviews incorporating data from 459 unique RCTs in diverse socio-economic and ethnic communities across 33 countries were included. R-AMSTAR quality score ranged from 20 to 42 (maximum 44). Apart from one outlier, the majority of reviews found an HbA1c improvement between 0.2% and 0.6% (2.2-6.5 mmol/mol) at 6 months post-intervention, but attenuated at 12 and 24 months. Impact on secondary outcomes was inconsistent and generally non-significant. Diverse self-management support strategies were employed; no single approach appeared optimally effective (or ineffective). Effective programmes tended to be multi-component and provide adequate contact time (>10 hours). Technology-facilitated self-management support showed a similar impact as traditional approaches (HbA1c MD -0.21% to -0.6%). CONCLUSIONS: Self-management interventions using a range of approaches improve short-term glycaemic control in people with type 2 diabetes including culturally diverse populations. These findings can inform researchers, policy-makers and healthcare professionals re-evaluating the provision of self-management support in routine care. Further research should consider implementation and sustainability. | en_US |
dc.description.sponsorship | MC is supported by the Scottish School of Primary Care (academic fellowship in general practice). | en_US |
dc.format.extent | e024262 - ? | en_US |
dc.language | eng | en_US |
dc.language.iso | en | en_US |
dc.relation.ispartof | BMJ Open | en_US |
dc.rights | CC-NC-ND | |
dc.subject | Supported Self-management | en_US |
dc.subject | health policy | en_US |
dc.subject | meta-review | en_US |
dc.subject | primary care | en_US |
dc.subject | quality In health care | en_US |
dc.subject | Blood Pressure | en_US |
dc.subject | Body Mass Index | en_US |
dc.subject | Culturally Competent Care | en_US |
dc.subject | Diabetes Mellitus, Type 2 | en_US |
dc.subject | Glycated Hemoglobin A | en_US |
dc.subject | Health Behavior | en_US |
dc.subject | Humans | en_US |
dc.subject | Lipids | en_US |
dc.subject | Patient Care Team | en_US |
dc.subject | Quality of Life | en_US |
dc.subject | Self Efficacy | en_US |
dc.subject | Self-Management | en_US |
dc.title | Supported self-management for people with type 2 diabetes: a meta-review of quantitative systematic reviews. | en_US |
dc.type | Article | |
dc.rights.holder | 2017 Elsevier Ltd | |
dc.identifier.doi | 10.1136/bmjopen-2018-024262 | en_US |
pubs.author-url | https://www.ncbi.nlm.nih.gov/pubmed/30552277 | en_US |
pubs.issue | 12 | en_US |
pubs.notes | Not known | en_US |
pubs.publication-status | Published online | en_US |
pubs.volume | 8 | en_US |