Impact of self-care programmes in type 2 diabetes mellitus population in primary health care: Systematic review and meta-analysis
Corresponding Author
Jorge Caro-Bautista RN, PhD
Care Coordinator
Servicio Andaluz de Salud, Distrito Sanitario Málaga-Valle del Guadalhorce, Málaga, Spain
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Correspondence
Jorge Caro-Bautista, Servicio Andaluz de Salud, Distrito Sanitario Málaga-Valle del Guadalhorce, Málaga, Spain.
Email: [email protected]
Search for more papers by this authorShakira Kaknani-Uttumchandani RN, PhD
Assistant Professor
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
Search for more papers by this authorSilvia García-Mayor RN, PhD
Assistant Professor
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
Search for more papers by this authorFrancisca Villa-Estrada RN, PhD
Care Coordinator
Servicio Andaluz de Salud, Distrito Sanitario Málaga-Valle del Guadalhorce, Málaga, Spain
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Search for more papers by this authorJuan Carlos Morilla-Herrera RN, PhD
Director of Nursing Services
Servicio Andaluz de Salud, Distrito Sanitario Málaga-Valle del Guadalhorce, Málaga, Spain
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
Search for more papers by this authorÁlvaro León-Campos RN, PhD
Assistant Professor
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Hospital Regional Universitario de Málaga, Málaga, Spain
Search for more papers by this authorAlberto José Gómez-González RN, MSc
Assistant Professor
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Search for more papers by this authorJosé Miguel Morales-Asencio RN, PhD
Professor
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
Search for more papers by this authorCorresponding Author
Jorge Caro-Bautista RN, PhD
Care Coordinator
Servicio Andaluz de Salud, Distrito Sanitario Málaga-Valle del Guadalhorce, Málaga, Spain
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Correspondence
Jorge Caro-Bautista, Servicio Andaluz de Salud, Distrito Sanitario Málaga-Valle del Guadalhorce, Málaga, Spain.
Email: [email protected]
Search for more papers by this authorShakira Kaknani-Uttumchandani RN, PhD
Assistant Professor
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
Search for more papers by this authorSilvia García-Mayor RN, PhD
Assistant Professor
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
Search for more papers by this authorFrancisca Villa-Estrada RN, PhD
Care Coordinator
Servicio Andaluz de Salud, Distrito Sanitario Málaga-Valle del Guadalhorce, Málaga, Spain
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Search for more papers by this authorJuan Carlos Morilla-Herrera RN, PhD
Director of Nursing Services
Servicio Andaluz de Salud, Distrito Sanitario Málaga-Valle del Guadalhorce, Málaga, Spain
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
Search for more papers by this authorÁlvaro León-Campos RN, PhD
Assistant Professor
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Hospital Regional Universitario de Málaga, Málaga, Spain
Search for more papers by this authorAlberto José Gómez-González RN, MSc
Assistant Professor
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Search for more papers by this authorJosé Miguel Morales-Asencio RN, PhD
Professor
Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
Search for more papers by this authorFunding information
The work was partially supported by the Andalusian Health Ministry (Research Grant: PI-0005-2015) in its call for primary care (http://www.juntadeandalucia.es/fundacionprogresoysalud/ gestionconvocatorias/), by the Carlos III Health Institute (Research Grant: PI14/01127) via the cofunded project with the European Regional Development Fund “Una manera de hacer Europa” (http://www.isciii.es/ISCIII/es/contenidos/fd-investigacion/fd-financiacion/convocatorias-ayudas-accion-estrategica-salud.shtml) and by the 2014 announcements of grants for the performance of research projects in District of Primary Healthcare of Málaga-Valle del Guadalhorce (2014-DGSM-COD4).
Abstract
Aims and Objectives
To evaluate the effectiveness of self-care programmes in type 2 diabetes mellitus (T2DM) population in primary health care.
Background
The impact of educational interventions on T2DM has been evaluated in various contexts, but there is uncertainty about their impact in that of primary care.
Design
Systematic review and meta-analysis.
Methods
A search was conducted in PubMed, CINAHL, WOS and Cochrane databases for randomised controlled trials carried out in the period January 2005-December 2017, including studies with at least one face-to-face educational interventions. The quality of the evidence for the primary outcome was evaluated using the GRADE System. A meta-analysis was used to determine the effect achieved although only the results classified as critical or important were taken into consideration. Checklist of Preferred Reporting Items for Systematic Reviews and Meta-analyses has been followed. PROSPERO registration Number: CRD42016038833.
Results
In total, 21 papers (20 studies) were analysed, representing a population of 12,018 persons with T2DM. For the primary outcome, HbA1c, the overall reduction obtained was −0.29%, decreasing the effect in long-term follow-up. The quality of the evidence was low/very low due to very serious risk of bias, inconsistency and indirectness of results. Better results were obtained for individual randomised trials versus cluster designs and in those programmes in which nurses leaded the interventions. The findings for other cardiovascular risk factors were inconsistent.
Conclusions
Educational interventions in primary care addressing T2DM could be effective for metabolic control, but the low quality of the evidence and the lack of measurement of critical results generates uncertainty and highlights the need for high-quality trials.
Relevance to clinical practice
Most of self-care programmes for T2DM in primary care are focused on metabolic control, while other cardiovascular profile variables with greater impact on mortality or patient-reported outcomes are less intensely addressed.
CONFLICT OF INTEREST
The authors have no conflict of interest.
Supporting Information
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