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. 2016 May 25;7(10):209–229. doi: 10.4239/wjd.v7.i10.209

Table 1.

Diabetes management: Diabetes Prevention Program like interventions (allied health professionals and lay member facilitated)

Country Ref. Objective Study design Sample size/characteristics Components of intervention Measurements Outcome measures Conclusion
Argentina Gagliardino et al[29] To evaluate effect of combined physician and/or patient education and effect of system interventions (100% coverage of medications, formalized data collection) Randomized 2 × 2 design trial n = 468, 117 in control group (g1), 117 in physician education group (g2), 117 in patient education group (g3), 117 in physician and patient education group (g4), T2DM for at least 2 yr, age b/w25 and 75 yr For T2DM pts - 90-120 min weekly teaching units For physicians - 25 structured module interactive course HbA1c, BMI, FBG 0, 6, 12, 18, 24, 30, 36, 42 mo HbA1c decreased from 4 mmol/mol to 10 mmol/mol (P < 0.05), with the largest decrease being in g4 (physician and patient education group)
Brazil Cezaretto et al[30] To evaluate effect of interdisciplinary intervention program Two group randomized longitudinal n = 135, 60 in traditional group, 75 in intensive group, high risk individuals for T2DM between ages 18 and 79 Intensive Intervention group - 2 h group sessions from 4 sessions in month 1 to 2 sessions in month 2 and 1 monthly sessions until 9 mo, print materials, telephone calls, interdisciplinary team included endocrinologist, psychologist, nutritionist, and physical educator FBS, BMI, post load plasma glucose 0 and 9 mo Intensive intervention group decreased fasting plasma glucose from 98.9 to 95.3 (P < 0.001), while the traditional intervention group was not significant. Intensive intervention group BMI decreased from 31.7 to 30.9 (P < 0.001) while the traditional intervention group BMI decreased from 29.9 to 29.1 (P < 0.001)
Brazil Chaves-Fonseca et al[31] To evaluate effectiveness of “staged diabetes management” protocol RCT n = 113, 47 in control group, 66 in intervention group > 30 yr old, T2DM SDM protocol (as developed International diabetes center) with doctor, nurse, pharmacist and health technicians HbA1c, random glucose 0, 12 and 18 mo Random glucose decreased from 12.7 to 10.5 (P = 0.004) and HbA1c decreased from 9.2 to 7.7 (P < 0.001) in intervention group, while there was no significant change in intervention group
Brazil Mourão et al[49] To evaluate effectiveness of pharmaceutical care program RCT n = 100, 50 in control and interventional, > 18 yr, HbA1c > 7%, post prandial capillary glucose > 180 mg/dL, T2DM Two research pharmacists conducted education on drug therapy problems, medication adherence HbA1c, fasting blood glucose 0 and 6 mo HbA1c decreased -0.6% and fasting blood glucose decreased -21.4 mg/dL in intervention group (P = 0.001)
Brazil Correr et al[50] To evaluate effect of pharmacotherapy follow up RCT n = 96, 50 in intervention and 46 in control, > 30 yr old, diagnosed T2DM, oral meds or insulin use Monthly visit with pharmacist for education, suggestion in changes of medication and dosage changes HbA1c, fasting capillary glycemia 0 and 12 mo Relative to the control group, the intervention group exhibited greater glycosylated haemoglobin (HbA1) reduction [-2.2% (95%CI, -2.8%: -1.6%) vs -0.3 (95%CI, -0.8:0.2); P < 0.001] and greater fasting capillary glycaemia reduction [-20.1 mg/dL (95%CI, -31.9 mg/dL: -8.3 mg/dL) vs 4.3 mg/dL (95%CI, -13.4 mg/dL: 22.2 mg/dL); P = 0.022]
Brazil Borges et al[51] To evaluate effect of pharmaceutical care Two group experimental n = 71, 31 in control group and 40 in intervention group, > 18 yr old, T2DM Individual visit with pharmacist monthly, patient education, dosage adjustment Fasting glycemia, HbA1c 0 and 12 mo A significant reduction in the levels of glycosylated haemoglobin was detected in patients in the pharmaceutical caregroup, and an average increase was observed in the control group
Bulgaria Petkova et al[52] To evaluate effectiveness of educational programme by pharmacists Single group n = 24, 31-75 yr, diagnosed T2DM Educational Sessions with five teaching units over one month Blood glucose levels, frequency of hypoglycemic Incidents 0, 1, 3 and 6 mo Education of diabetic patients by pharmacists can decrease the economic cost of T2DM management and benefit patients. Blood glucose levels decreased from 8 to 7.2 mmol/L (P < 0.05)
Bulgaria Tankova et al[26] To evaluate effectives of a teaching program 1 to 2 yr after implementation RCT n = 560, 319 in experimental group, 241 in control group, Insulin treated T1 + 2DM Geneva-Düsseldorf Education Session Model (consists of lessons on DM, practical training on self-control, injection techniques, preparing meals, construction of menu, physical exercise) education is conducted by team of doctors, nurses and rehab therapist using interactive approach HbA1c, Well-being as measured by 22-item questionnaire 0, 12 and 24 mo Structured teaching education program improves patient's well being. Improvement in glycemic control of educated patients as compared to control group (P < 0.01) and increase in overall wellbeing (P < 0.001)
Cameroon Kengne et al[35] To evaluate effectiveness of nurse-led care Population based sample participants referred to either one of the 2 rural clinics or one of the 3 urban clinics n = 225, 39 in rural clinic and 186 in urban, T2DM Education, clinic visits, monitoring, follow-up Mean fasting capillary glucose 0 and visit 6 (varied over 1110 patient-months) Difference in mean levels of fasting glucose between baseline and final visit was 1.6 mmol/L (P < 0.001)
Cameroon Labhardt et al[36] To evaluate effectiveness of non-physician clinician facility care Included all of the 75 clinics in central region of cameroon n = 79, T2DM Protocol-drive care by non-physician clinicians (nurses), diet and lifestyle education Fasting Plasma glucose 0 and 2 yr Fasting plasma glucose decreased -7.8 mmol/L (P < 0.001)
China Liu et al[28] To evaluate effectiveness of group visit and self management model RCT n = 176, 98 in intervention group and 78 in control group, T2DM, between 35-80 yr 12 1.5 h sessions on self management education, one-on-one visits with health care providers, including nurse, general practitioner and diabetes specialist BMI, SBP, DBP 0 and 12 mo No significant changes in BMI or DBP in either group, significant change in SBP in intervention group of 1.48 (P = 0.04). Larger studies need to be done to determined effects of group visits on blood glucose and other metabolic parameters
China Chen et al[119] To evaluate effectiveness of nurse diabetes intervention Quasi-experiment, pre and post-test n = 150, 75 in each control and case groups, > 65 yr, diagnosed T2DM, HbA1c > 8.5% Self-management education with visits lasting 30 min each, telephone follow-up two weekly BP, HbA1c, Weight 0 and 3 mo Nurse-led education and consultation is effective in improving management in T2DM patients. HbA1c in case group changed -0.8% (P < 0.001) while the control group had no significant change
Iran Sarrafzadegan et al[27] To evaluate effect of comprehensive, community based healthy lifestyle program on cardiometabolic risk factors Multi-stage cluster, 2 areas n = 9032, 4179 in intervention area, 4853 in reference area, general population (htn, metabolic syndrome, diabetes, cardiac disease pts) Public education through mass media, healthy nutrition, increased physical activity, tobacco control and coping with stress Cholesterol, abdominal obesity, fasting blood glucose 0, 7 yr Mean fasting blood glucose increased, but prevalence of abdominal obesity, htn, hypercholesterolemia and hypertriglyceridemia decreased significantly in intervention area (P < 0.05), no significant change in prevalence of diabetes
Iran Farsaei et al[47] To evaluate effectiveness of pharmacist-led education program RCT n = 172, diagnosed T2DM, HbA1c > 7% Two educational sessions followed by weekly phone calls and appointments, medication consultation FBS, HbA1c 0 and 3 mo There is improvement in diabetes management by involvement of pharmacist in multidisciplinary health care team. HbA1c and FBS (-1.7% and -30.8 mg/dL) were decreased in intervention group (P < 0.001)
Jamaica Less et al[53] To evaluate effectiveness of involvement of LDFs Two group experimental n = 293, 158 in intervention group and 135 in control group, 25-75 yr, diagnosed T2DM Educational Sessions during 3 monthly visits, self-monitoring forms HbA1c, BMI 0 and 6 mo Patient education by LDFs improved glycemic control of T2DM patients. HbA1c reduced from 0.6% in intervention group (P < 0.001) while comparison group had an increase of 0.6% (P < 0.001)
Jordan Jarab et al[48] To evaluate effectiveness of pharmacist-led pharmaceutical care intervention program RCT n = 171, 85 in intervention group and 86 in control group, > 18 yr, diagnosed T2DM for at least 1 yr, HbA1c > 7.1% Medication consultation, lifestyle education, follow-up calls 8 weekly FBG, HbA1c, BMI, Lipid Panel, BP 0 and 6 mo Pharmacist-led pharmaceutical care led to an improvement in glycemic parameters. Intervention group had a mean reduction of 0.8% HbA1c verses a mean increase of 0.1% in the usual care group (P = 0.019). FBG in intervention group had a reduction of 2.3 mmol/L and the intervention group showed an increase of 0.9 mmol/L (P = 0.014)
Malaysia Tan et al[33] To evaluate effectiveness of structured diabetes education program Single blind RCT n = 164, 82 in control and intervention group, > 18 yr, diagnosed T1 + T2DM, HbA1c > 7% Educational sessions once a month for 3 mo self-care practices, individual counseling with nurse and physician HbA1c, SMBG frequency 0, 1, 2 and 3 mo A self-management diabetes education program improves the well-being of diabetic patients. Intervention group had lower HbA1c than control group by the end of study (intervention group – P < 0.001, hbac decreased 8.75 ± 1.75; control group 9.67 ± 2.01)
Mexico Gallegos et al[39] To evaluate effectiveness of nurse-led education Two group quasi-experiment n = 45, 25 in experimental group and 20 in control group, diagnosed T2DM 6 Educational sessions lasting 90 min each, 20 individual counseling sessions lasting 30 to 90 min throughout 50 wk HbA1c, psychological adaptation, diabetes care skills 0, 3, 6, 9 and 12 mo Counseling and education model is an effective intervention to improve metabolic control in T2DM patients. HbA1c decreased from 10.36 at baseline to 8.04 (P = 0.000) while comparison group HbA1c levels changed from 9.44 to 9.77
Samoa DePue et al[37] To evaluate effectiveness of nurse-community health workers team intervention for diabetes management Cluster rct n = 243, 140 in usual care group, 104 in intervention group, > 18 yr, T2DM Group visits and individual visits based on risk of patients HbA1c 0 and 12 mo Mean HbA1c was significantly lower among CHW participants, compared with usual care, after
South Africa Price et al[40] To determine long-term glycemic outcome of a structured nurse-led care Single group, single center n = 80, T2DM Nurse led drug titration, structured empowerment based diabetes education HbA1c, BMI 0, 6 mo, 18 mo, 2 yr, 4 yr BMI at 6 and 18 mo was significantly higher than at baseline (both P < 0.01), but the 48 mo value was not significantly different from 0 mo. Compared with baseline, HbA1c falls were all significant (P < 0.001 for 6, 18 and 24 mo and P = 0.015 for 48 mo)
South Africa Gill et al[41] To determine effectiveness for a nurse-led intervention and education based program Single group n = 284, diagnosed T2DM Self-management education, pictorial based education HbA1c, BMI 0, 6 and 18 mo Nurse-led protocol and education based intervention improve glycemic parameters in diabetic patients. HbA1c was 11.6% at baseline, but improved to 7.7% at 18 mo
Thailand Wattana et al[42] To evaluate effectiveness of self-diabetes management program RCT n = 147, 72 in control and 75 in experimental, > 35 yr, Diagnosed T2DM, FPG > 140 mg 120 min of small group diabetes education class, four 90 min group discussions and two individual home visit sessions by nurse educators HbA1c, CHD risk, quality of life assessment 0 and 6 mo A diabetes self-management program is effective in improving metabolic control for T2DM patients. HbA1c change was -0.68 in experimental group (P = 0.029) and 0.07 in control group
Thailand Navicharern et al[43] To evaluate effect of multifaceted nurse-coaching intervention Quasi experiment, 2 group n = 40, 20 in control and experimental group, T2DM 3 individualized sessions, 2 follow-up phone calls over 12 wk HbA1c 0 and 3 mo Mean average of HbA1c of the experimental group was significantly lower than that of the control group [x(exp) = 7.10, SD = 0.67 vs x(cont) = 7.72, SD = 0.97; P ≤ 0.5]
Thailand Suppapitiporn et al[45] To evaluate effect of pharmacist led intervention RCT n = 360, 180 in control and experimental group each (divided into 4 groups), T2DM Drug counseling, special medical containers, diabetes booklet (in experimental group, 1 group received only drug counseling, 2nd group received drug counseling + special medical containers, 3rd group received drug counseling + diabetes booklet, 4th group received all) HbA1c, mean fasting glucose 0, 3, 6 mo Most favorable glycemic outcome was the group that received all of the interventions; mean FPG was reduced from 147.46 ± 36.07 to 125.38 ± 31.12 mg% (P < 0.000) in 1st visit (3 mo later) and still reducing effect on the 2nd visit (6 mo later) mean FPG from 147.46 ± 36.07 to 130.21
Thailand Oba et al[44] To evaluate effectiveness of community participation prevention program in diabetes prevention Single group, pre-post test n = 160, > 35 yr, BMI > 23 kg/m2, waist circumference > 80 cm (women) and > 90 cm (men), FBS 100-125 mg/dL, no baseline diabetes (but at risk patients) Nutritional education provided by nurse practitioner, fitness schedule in daily exercise log BMI, SBP, DBP 0, 1, 2, 3 mo Average mean scores of the BMI (P < 0.001), SBP (P < 0.01) and waist circumference (P < 0.01) among persons who were at risk of DM after the intervention were lower than before intervention
Tunisia Jenhani et al[32] To evaluate effectiveness of education program on diabetes control Pre/post-test experiment n = 87, diagnosed T1 + T2DM, insulin usage Six education sessions, interactive learning conducted by nurse and general practitioner HbA1c, BMI, anxiety level 0 and 6 mo Education program led to an improvement in diabetes control in patients. HbA1c decreased from 8.80% pre intervention to 7.62% (P < 0.000001)
Turkey Mollaoğlu et al[25] To evaluate effectiveness of nurse-led planned education RCT n = 50, 25 in experimental and control group, 18-65 yr, diagnosed T2DM 3 Educational Sessions 30-40 min each, home visit follow-ups HbA1c, FBS, lipid panel 0, 1 and 2 mo Regular, structured, repeated education improves glycemic parameters in T2DM patients, HbA1c and FBS levels changes were not statistically significant
Turkey Turnacilar et al[46] To evaluate effectiveness of pharmaceutical care program Prospective longitudinal, cluster n = 43, T2DM 6 pharmacy visits, drug counseling, weight control importance Capillary whole blood glucose, BMI 0, 15, 30, 45, 60, 75, 90 d Mean fasting blood glucose decreased from 167 to 128 mg/dL (P < 0.001)
Turkey Kitiş et al[38] To evaluate effect of home monitoring by public health nurse Quasi experimental, single group, time series n = 34, T2DM for at least 2 yr Caloric calculation, exercise recommendations, medication compliance, monitoring blood glucose, education study group, booklets, 1st two months frequency of visits based on patients needs, with 2nd mo, visits every 2 mo HbA1c, fasting blood glucose, postmeal blood glucose 0 and 6 mo HbA1c decreased from 7.3% to 6.7% (P = 0.000), FBG decreased from 186 to 150 (P = 0.001), postmeal blood glucose decreased from 204 to 156 (P = 0.000)

T2DM: Type 2 diabetes mellitus; RCT: Randomized control trial; BMI: Body mass index; HbA1c: Hemoglobin A1c; LDFs: Lay diabetes facilitators.