. 2017 Oct 16;7(10):e016857. doi: 10.1136/bmjopen-2017-016857

Table 4.

Summary of evidence from quantitative research syntheses

Intervention	Number of systematic reviews/meta-analysis, total participants	First author, year	Primary results/findings		Rating the evidence of effectiveness
Patients with acute coronary syndrome
General health education	Six/161 997 patients (Goulding et al, 2010⁵¹ did not give the total sample size)	Ghisi, 2014⁵⁰	Knowledge	91% studies*	Some evidence
			Behaviour	77%/84%/65% studies*
			Psychosocial indicators	43% studies*
		Brown, 2013³⁷	Mortality
			MI
			Revascularisations
			Hospitalisations
			HRQoL
			Withdrawals/dropouts
			Healthcare utilisation and costs
		Brown, 2011⁷⁰	Total mortality
			MI
			CABG
			Hospitalisations
			HRQoL	63.6% studies*
			Healthcare costs	40% studies*
			Withdrawal/dropout
		Goulding, 2010⁵¹	Beliefs	30.08% studies*
		Goulding, 2010⁵¹	Secondary outcomes
		Fernandez, 2007⁴⁸	Smoking
			Cholesterol level
			Multiple risk factor modification
		Kotb, 2014⁵⁹	All-cause hospitalisation
			All-cause mortality
			Smoking cessation
			Depression
			Systolic blood pressure
			Low-density lipoprotein
			Anxiety
Psychoeducational interventions	Six/37 883 patients	Barth, 2015⁶⁹	Abstinence by self-report or validated		Sufficient evidence
		Dickens, 2013⁴⁵	Depression
		Aldcroft, 2011³¹	Smoking cessation
		Aldcroft, 2011³¹	Physical activity
		Huttunen-Lenz,2010⁵⁶	Prevalent smoking cessation
			Continuous smoking cessation
			Total mortality
		Barth, 2008³⁶	Abstinence by self-report or validated
		Barth, 2008³⁶	Smoking status
		Barth, 2006³⁵	Abstinence
		Barth, 2006³⁵	Smoking status
Secondary prevention educational interventions (including Internet-based secondary prevention)	Three/25 154 patients	Devi, 2015⁴⁴	Mortality		Some evidence
			Revascularisation
			Total cholesterol
			HDL cholesterol
			Triglycerides
			HRQOL
		Auer, 2008³⁴	All-cause mortality
			Readmission rates
			Reinfarction rates
			Smoking cessation rates
		Clark, 2005⁴¹	Mortality
			MI
			Quality of life	Most of the included studies*
Patients with T2DM
General health education	Five/2319 patients (Choi et al, 2016⁴⁰; Loveman et al, 2008⁶⁰; Zabaleta et al, 2007⁷⁹ did not give the total sample size)	Choi, 2016⁴⁰	HbA1c		Some evidence
		Saffari, 2014⁷⁴	Glycaemic control
		Duke, 2009⁴⁶	HbA1c
			BP
			Knowledge, psychosocial outcomes and smoking habits	No data
			Diabetes complications or health service utilisation and cost analysis	No data
		Loveman, 2008⁶⁰	Diabetic control outcomes	46.15% studies*
			Weight	66.67% studies*
			Cholesterol or triglycerides	40.00% studies (+)
		Zabaleta, 2007⁷⁹	HbA1c	4.8% studies*
Culturally appropriate health education	Eight/20 622 patients (Ricci-Cabello et al, 2014⁷³ and Gucciardi et al, 2013⁵² did not give the total sample size)	Creamer, 2016⁴²	HbA1c		Some evidence
			HRQoL
			AEs	No AEs
		Ricci-Cabello, 2014⁷³	HbA1c
			Diabetes knowledge	73.3% studies*
			Behaviours	75% studies*
			Clinical outcomes	Fasting blood glucose, HbA1c and BP improved in 71%, 59% and 57% of the studies
		Attridge, 2014³³	HbA1c
			Knowledge scores
			Clinical outcomes
			Other outcome measures	Showed neutral effects
		Gucciardi, 2013⁵²	HbA1c levels	3 of 10 studies*
			Anthropometrics	3 of 11 studies*
			Physical activity	One of five studies*
			Diet outcomes	Two of six studies*
		Nam, 2012⁶²	HbA1c level
		Hawthorne, 2010⁵⁴	HbA1c
		Hawthorne, 2010⁵⁴	Knowledge scores
		Khunti, 2008⁵⁸	Knowledge levels	Only one study reporting a significant improvement
		Khunti, 2008⁵⁸	Biomedical outcomes	Only one study reporting a significant improvement
		Hawthorne, 2008⁵³	HbA1c
			Knowledge scores
			Other outcome measures
Lifestyle interventions+behavioural programme	Six/10 440 patients (Huang et al, 2016⁵⁵; Pillay et al, 2015⁷¹ and Ramadas et al, 2011⁷⁷ did not give the total sample size)	Huang, 2016⁵⁵	HbA1c		Some evidence
			BMI
			LDL-c and HDL-c
		Chen, 2015³⁹	HbA1c
			BMI
			SBP
			DBP
			HDL-c
		Terranova, 2015⁷²	HbA1c level
		Terranova, 2015⁷²	Weight
		Pillay, 2015⁷¹	HbA1c levels
		Pillay, 2015⁷¹	BMI
		Ramadas, 2011⁷⁷	HbA1c	46.2% studies *
		Gary, 2003⁴⁹	Fast blood sugar
			Glycohaemoglobin
			HbA1
			HbA1c
			Weight
Self-management educational interventions	Nine/19 597 patients (Minet et al, 2010⁶¹; Fan et al, 2009⁴⁷ and Norris et al, 2001⁶⁴ did not give the total sample size)	Pal, 2014⁶⁷	Cardiovascular risk factors		Sufficient evidence
			Cognitive outcomes
			Behavioural outcomes	Only one study reporting a significant improvement
			AEs	No AEs
		Vugt, 2013⁷⁵	Health behaviours	7 of 13 studies *
			Clinical outcomes measures	Nine studies *
			Psychological outcomes	Nine studies *
		Pal, 2013⁶⁸	HbA1c
			Depression
			Quality of life
			Weight
		Steinsbekk, 2012⁷⁶	HbA1c
			Main lifestyle outcomes
			Main psychosocial outcomes
		Minet, 2010⁶¹	Glycaemic control
		Fan, 2009⁴⁷	Diabetes knowledge
			Overall self-management behaviours
			Overall metabolic outcomes
			Overall weighted mean effect sizes
		Deakin, 2005⁴³	Metabolic control (HbA1c)
			Fasting blood glucose levels
			Weight
			Diabetes knowledge
			SBP
			Diabetes medication
		Norris, 2002⁶⁵	Total GHb
		Norris, 2001⁶⁴	Knowledge
			Self-monitoring of blood glucose
			Self-reported dietary habits
			Glycaemic control
Therapeutic education	One/total sample: unclear	Odnoletkova, 2014⁶⁶	Cost-effectiveness	Overall high in studies on prediabetes and varied in studies on T2DM	Insufficient evidence
Foot health education	One/total sample: unclear	Amaeshi³²	Diabetes complications		Some evidence
Foot health education	One/total sample: unclear	Amaeshi³²	Incidence of LEA		Some evidence
Group medical visit	One/2240 patients	Burke, 2011³⁸	HbA1c		Some evidence
			BP and DBP
			SBP
			Cholesterol—LDL
Psychoeducational intervention	One/1431 patients	Alam, 2009³⁰	HbA1c		Some evidence
Psychoeducational intervention	One/1431 patients	Alam, 2009³⁰	Psychological status		Some evidence
Interventions aimed at improving adherence to medical treatment recommendations	Three/4907 patients (Lun Gan et al, 2011⁵⁷ did not give the total sample size)	Lun Gan, 2011⁵⁷	Oral hypoglycaemic adherence	Five of seven studies *	Some evidence
		Wens et al., 2008⁷⁸	Adherence	General conclusions could not be drawn
		Vermeire, 2005⁸⁰	HbA1c
Dietary advice	One/1467 patients	Nield, 2007⁶³	Glycaemic control (addition of exercise to dietary advice)		Insufficient evidence to determine
			Weight	Limited data
			Diabetic microvascular and macrovascular diseases	Limited data

*Intervention group is significantly better than control group, for example, ‘91% studies ’ means 91% studies reported a significant better compared with control group.

AEs, adverse events; BMI, body mass index; BP, blood pessure; CABG, coronary artery bypass graft surgery; HbA1c, glycated haemoglobin; HRQoL, health related quality of life; LDL-c, low-density lipoprotein cholesterol; LEA, lower extremity amputation; MI, myocardial infarction; RCTs, randomised controlled trials; SBP, systolic blood pressure, DBP, diastolic blood pressure, HDL-c, high density lipoprotein cholesterol; T2DM, type two diabetes mellitus.