Table 4. Outcomes of the DSME interventions.
| Author, Year | Outcome Measures | Results | ||
|---|---|---|---|---|
| Learning Outcomes | Behavioral Outcomes | Clinical Outcomes | ||
| Assah et al. [25] | - | Diet, exercise, foot care | HbA1c, BMI, FBS, cholesterol, blood pressure, HDL | • Significant reduction in HbA1c in the intervention group [–33 mmol/mol (–3.0%)] compared with controls [–14 mmol/mol (–1.3%)], P < 0.001 |
| • Significant reductions in FBS (–0.83 g/l P < 0.001), cholesterol (–0.54 g/l P < 0.001), HDL (–0.09 g/l, P < 0.001), BMI (–2.71 kg/m2 P < 0.001) and diastolic pressure (–6.77 mmHg, P < 0.001) | ||||
| • Diabetes self-care behaviors (diet, exercise and foot care) in the intervention group also improved significantly | ||||
| Bett, [26] | Self-efficacy, diabetes knowledge | - | HbA1c | • The experimental group had significant reduction levels of HbA1c (F (1, 122) = 9.989, p = 0.002), and improved diabetes knowledge (t = 7.218, p = <0.001) and self-efficacy (F (1, 117) = 14.342, p<0.001) |
| Debussche et al. [27] | Knowledge score | Dietary practices | HbA1c, weight, BMI, waist circumference, SBP & DBP | • A decrease in HbA1c levels of 1.05% (SD = 2.0; CI95%: 1.54; -0.56) in the intervention group compared with 0.15% (SD = 1.7; CI95%: -0.56; 0.26) in the control group, p = 0.006 |
| • Mean BMI change was -1.65 kg/m2 (SD = 2.5; CI95%: -2.25; -1.06) in the intervention group and +0.05 kg/m2 (SD = 3.2; CI95%: -0.71; 0.81) in the control group, p = 0.0005 | ||||
| • Mean waist circumference decreased by 3.34 cm (SD = 9.3; CI95%: -5.56; -1.13) in the intervention group and increased by 2.65 cm (SD = 10.3; CI95%: 0.20; 5.09) in the control group, p = 0.0003 | ||||
| • SBP and DBP improved in the intervention group than in the control group. Patients’ knowledge scores improved | ||||
| • No positive change in the diet diversity score as a crude index of diet quality was recorded, but qualitative changes in the diet were noted | ||||
| Gill et al. [28] | - | - | HbA1c, BMI, hypoglycemia | • HbA1c improved from 11.6 ± 4.5% at baseline to 8.7 ± 2.3% at 3 months and 7.7 ± 2.0% at 18 months |
| • Significant increase in BMI | ||||
| • No significant change in hypoglycemia | ||||
| Hailu et al. [29] | - | - | HbA1c, FBS, SBP, DBP | • Mean HbA1c significantly reduced by 2.88% within the intervention group and by 2.57% within the control group, but between group differences were not statistically significant |
| • Adjusted end-line FBS, SBP, and DBP were significantly lower in the intervention group, by 27 ± 9 mg/dL, 12 ± 3, and 8 ± 2 mmHg respectively | ||||
| Hailu et al. [30] | Diabetes knowledge, self-efficacy | Self-care behaviors | - | • Significant mean difference in diabetes knowledge (p = 0.044), dietary recommendations (p = 0.019) and foot care performed (p = 0.009) in the intervention group |
| • No significant differences within or between groups in the other self-care behaviors (exercise, glucose self-monitoring, smoking, alcohol consumption) or in diabetes self-efficacy | ||||
| Mash et al. [31] | Self-efficacy | Physical activity, use of diet plan, use of medication, foot care, & smoking | HbA1c, weight, waist circumference, SBP & DBP | • No significant improvement in the outcomes, apart from a significant reduction in mean SBP (-4.65 mmHg, 95% CI 9.18 to -0.12; P = 0.04) and DBP (-3.30 mmHg, 95% CI -5.35 to -1.26; P = 0.002) |
| Muchiri et al. [32] | - | Dietary behaviors | HbA1c, blood lipids, blood pressure, BMI | • No significant group difference in HbA1c (−0·64%, P = 0·15 at 6 months and −0·63%, P = 0·16 at 12 months) |
| • No significant group differences in BMI, lipid profile, and blood pressure | ||||
| • Starchy-food intake was significantly lower in the intervention group, 9·3 v. 10·8 servings/d (P = 0·005) at 6 months and 9·9 v. 11·9 servings/d (P = 0·017) at 12 months | ||||
| Afemikhe & Chipps [33] | - | - | FBS, BMI, SBP | • The intervention group had significantly lower FBS (p = 0.01) and BMI scores (.025) than the control group, but only FBS differed significantly between the two groups (p = .012) |
| • No significant group difference in SBP (p = .467) | ||||
| Essien et al. [34] | - | - | HbA1c | • Participants in the intervention group had significantly lower HbA1c levels compared to participants in the control group, with a mean estimated HbA1c difference of -1.8 (95% CI: -2.4 to -1.2) |
| Park et al. [35] | Diabetes knowledge | - | HbA1c, SBP, BMI | • Improvement in HbA1c (β -0.17, SE 0.09, P = 0.05) and SBP (β -5.67, SE 1.64, P = 0.001, with a median decrease from 132.4 mmHg to 127.5 mmHg) |
| • No changes in diabetes knowledge and BMI | ||||
| Asante et al. [36] | - | Diet, exercise, medication taking, foot care, and blood glucose monitoring | HbA1c | • HbA1c was significantly lower in the intervention group compared to the control group. The difference in mean HbA1c in the control group rose by +0.26 ± 1.30% (P = .282; 95% CI, −0.23 to 0.75), whereas that of the intervention group reduced by −1.51 ± 2.67% (P = .004; 95% CI, −2.51 to −0.51) |
| • Foot care practices improved | ||||
| • No significant improvements in the other outcomes | ||||
| Price et al., [37] | - | - | HbA1c and BMI | • HbA1c fell significantly to 8.1 ± 2.2% at 6 months and 7.5 ±2.0% at 18 months. At 24 months, it had risen to 8.4 ± 2.3%, and at 4 years post-intervention it was 9.7± 4.0% (still significantly lower than baseline, P = 0.015) |
| • BMI at 6 and 18 months was significantly higher than at baseline (both P < 0.01), but the 48-month value was not significantly different from 0 months | ||||
| Amendezo et al. [38] | - | - | HbA1c, SBP, DBP, BMI, FBG | • Statistically significant between group difference in change in HbA1c (p <0.001), FBG (p <0.001), SBP (p <0.005), DBP (p <0.02) and BMI (p <0.001) |
| Muchiri et al. [39] | Diabetes knowledge | - | - | • The intervention group had higher mean diabetes knowledge scores + 0.95 (p = 0.033) and + 2.05 (p < 0.001) at 6 and 12 months respectively |
| MakkiAwouda et al. [40] | Diabetes knowledge | - | - | • The average knowledge for the nature of diabetes significantly improved from 0.9408 to 1.74 (t-value = 7.38, p = 0.000) |
| Baumann et al. [41] | Confidence in self-management | Diet (healthy eating), physical activity | HbA1c, SBP, DBP, BMI | • The average DBP dropped from 85.39 to 76.27 mmHg (p<0.001), and the average HbA1c values changed from 11.10 to 8.31% (p<0.005) |
| • Average BMI values did not change | ||||
| • Of the health behaviors measured, only healthy eating significantly changed in a positive direction from pre-intervention to post-intervention, p<0.005. Confidence in self-management did not change | ||||
| van der Does & Mash [42] | - | Diet, physical activity, foot care, medication adherence | - | • Significant improvement in adherence to diet, physical activity, foot care |
| • No self-reported change in adherence to medication | ||||
| • Tobacco smoking reduced from 25% (21/84) to 18% (15/84) (p = 0.08) | ||||
| Gathu et al. [43] | - | - | HbA1c, BMI blood pressure | • No significant difference was noted in HbA1c between the two groups, with a mean difference of 0.37 (95% confidence interval: -0.45 to 1.19; p = 0.37) |
| • Blood pressure and BMI did not change from baseline to 6 months follow-up | ||||
HbA1c Glycated Hemoglobin, BMI Body Mass Index, FBS Fasting Blood Sugar, FBG Fasting Blood Glucose, HDL High Density Lipoprotein, SBP Systolic Blood Pressure, DBP Diastolic Blood Pressure