Abstract
BackgroundBrazilian records on glycemic control in patients with type 1 diabetes show treatment efficacy. Poor patient adherence to therapeutic proposals influences these results and can be associated with social, psychological, and economic aspects, besides others factors. The aim of this study was to evaluate the efficacy of psychological, telecare, and educational interventions to improve treatment compliance among patients with type 1 diabetes. Compliance was assessed indirectly using reduction of glycated hemoglobin (HbA1c) as the principal outcome measure.MethodsSystematic review and meta-analyses of randomized controlled clinical trials (RCTs) were performed using Medline, Embase, Cochrane and Scopus databases up to April 2015. The following medical subject headings were used: Diabetes Mellitus, Type 1, Patient Compliance or Adherence, Hemoglobin A, glycated, and Randomized Controlled Trial. The principal outcome was change in HbA1c between baseline and follow-up. Where appropriate, trials were combined in meta-analysis using fixed effects models.ResultsFrom 191 articles initially identified, 57 were full text reviewed, and 19 articles met the inclusion criteria providing data from 1782 patients (49.4 % males, age 18 years). The RCTs (2 to 24 months in duration) were divided into four groups according to type of intervention: psychology (seven studies; 818 patients), telecare (six studies; 494 patients); education (five studies; 349 patients), and psychoeducation (one study; 153 patients). All studies reported some type of adherence measurement of the interventions. Decrease in HbA1c was observed after psychology (MD −0.310; 95 % CI, −0.599 to −0.0210, P = 0.035) but not after telecare (MD −0.124 %; 95 % CI, −0.268, 0.020; P = 0.090) or educational (MD −0.001; 95 % CI, −0.202, 0.200; P = 0.990) interventions.ConclusionPsychological approaches to improve adherence to diabetes care treatment modestly reduced HbA1c in patients with type 1 diabetes; telecare and education interventions did not change glycemic control. However, the limited number of studies included as well as their methodological quality should be taken into account.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1207-6) contains supplementary material, which is available to authorized users.
Highlights
Brazilian records on glycemic control in patients with type 1 diabetes show treatment efficacy
The initial search comprised the following medical subject headings: “Diabetes Mellitus, Type 1” [Mesh], “Patient Compliance” [Mesh], or Adherence, “Hemoglobin A, Glycated” [Mesh], and related entry terms associated with a high sensitivity strategy for the search of randomized controlled clinical trial (RCT) available at http://www.sign.ac.uk/methodology/filters.html#random
67 studies were excluded due to duplication. Another 67 articles were excluded based on title or abstract: 24 studies were not performed in patients with type 1 diabetes; 31 studies had no information about treatment compliance; seven studies did not report glycated hemoglobin (HbA1c); and five studies had a non-randomized design
Summary
Brazilian records on glycemic control in patients with type 1 diabetes show treatment efficacy. The aim of this study was to evaluate the efficacy of psychological, telecare, and educational interventions to improve treatment compliance among patients with type 1 diabetes. A seminal study published in recent decades clearly demonstrated that intensive glycemic treatment promoting lower glycated hemoglobin (HbA1c) values, as compared to standard care, can prevent or postpone chronic diabetic complications [1]. Follow-up of these patients after the end-of-studies demonstrated that past strict glycemic control was associated with a low prevalence of complications years later. Reduction in the risk of cardiovascular, renal, and ocular disease by strict glycemic control was recently reinforced in a systematic review in these patients [5]. HbA1c measurement has been widely used to evaluate glycemic control in patients with diabetes. Patients have to be able to adhere to many procedures such as self-blood glucose monitoring, diet plan, insulin administration and dose titration, and exercise [6]
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