Impact of patient-centred diabetes self-management education targeting people with type 2 diabetes: an integrative review.

Abstract

To synthesize primary research into the impact of person-centred diabetes self-management education, and support that targets people with type 2 diabetes, on behavioural, psychosocial and cardiometabolic outcomes and to identify effective mechanisms underlying positive outcomes of person-centred diabetes self-management education and support. Using Whittemore and Knafl's integrative review method, we conducted a systematic search of peer-reviewed literature published between January 2008 and June 2019 using PubMed, Scopus and CINAHL. After article selection according to established criteria, study quality was assessed using Critical Appraisal Skills Programme checklists for cohort studies, randomized controlled trials and qualitative research. From 1901 identified records, 22 (19 quantitative, two qualitative, and one mixed methods) were considered eligible for inclusion. Interventions were categorized by content, medium of delivery, and outcomes. Qualitative studies, quantitative cohort studies and randomized controlled trials demonstrated positive outcomes, with no differences in success rates across study design. Interventions were largely successful in improving HbA1c and patient-reported outcomes such as quality of life but had limited success in lowering cholesterol and weight, or initiating long-term improvements in lifestyle behaviours. Primary objectives were achieved more often than secondary objectives, and studies with fewer outcomes appeared more successful in achieving specific outcomes. Person-centred diabetes self-management education and support has demonstrated a considerable impact on desired diabetes-related outcomes in people with type 2 diabetes. To advance the field further, new studies should take advantage of systematic and transparent approaches to person-centred diabetes self-management education.