Table 1.
Characteristics of randomized controlled trails in this meta-analysis.
| Study: author, year, country | Sample size (I/C) | Mean age (SD) | Duration of diabetes, y | Intervention/duration, mo | Indicator/ the assessment tool | Main findings |
| Anderson et al[3] (1995) USA | 22/23 | 50 | not described | I: 6-wk Empowerment Program. Six 2-h group sessions offered weekly. C: 6-wk Control Period/6 wks | HbA1c self-efficacy subscales DAS t0: Baseline t1: Follow-up, 6 wk | The intervention group showed a significant reduction in HbA1c levels, and gains over the control group on 4 of the eight self-efficacy subscales and 2 of the 5 diabetes attitude subscales. |
| Anderson et al[16] (2005) USA | 125/114 | 61.0 (11.4) | 8.5 (8.6) | I: 6-wk Empowerment Program. Six weekly 2-h group sessions. C: 6-wk Control period/6 wks | HbA1c, TC, SBP, DBP, DES t0: Baseline t1: Post, 6 wk | No significant difference in change in HbA1c was found between groups during the first 6 weeks. |
| Deakin et al[12] (2006) UK | 157/157 | I = 61.3 (9.7) C = 61.8 (11.0) | I = 6.7 (6.4) C = 6.7 (6.7) | I: Six weekly group sessions, each lasted 2 h of self-management education, based on theories of empowerment and discovery learning C: Routine care + diabetes education and review/6 wk | HbA1c, TC, SBP, DBP, HDL, LDL, BMI DES Diabetes knowledge score Self-care activity t0: Baseline t1: Follow-up, 4 mo t2: Follow-up, 14 mo | By 14 mo the X-PERT group compared with the control group showed significant improvements in the mean HbA1c, BMI, total cholesterol, self-empowerment, diabetes knowledge. |
| Adolfsson et al[7] (2007) Sweden | 42/46 | I = 62.4 (8.9) C = 63.7 (9.0) | I = 6.5 (3.9) C = 6.7 (4.2) | I: 4–5 Empowerment group education sessions, each lasted 2.5 h + routine diabetes care C: Routine diabetes care/not described | HbA1c, BMI diabetes knowledge self-efficacy satisfaction with daily life t0: Baseline t1: Follow-up, 12 mo | No significant differences were found in self-efficacy, BMI and HbA1c between the intervention and control group. |
| Cooper et al[10] (2008) UK | 23/36 30/36 | 59 | 6 | I: Empowerment-based educational system, sessions weekly for 8 wk lasting 2 h C: Routine diabetes care/8 wk | HbA1c, BMI self-care activities t0: Baseline t1: Follow-up, 6 mo t2: Follow-up, 12 mo | The educational program was associated with benefits in HbA1c levels at 6 mo follow-up compared to controls. |
| Anderson et al[25] (2009) USA | 156/154 | I = 55.5 (11.3) C = 55.7 (11.5) | I = 8.6 (8.1) C = 8.0 (7.8) | I: Empowerment-based Diabetes Self-Management Consultant (DSMC). C: Mailed metabolic Assessments Only (MAO)/not described | HbA1c DES-SF, PAID, PHQ-9, DSMC t0: Baseline t1: Follow-up, 24 mo | HbA1c values remained stable for the DSMC group but increased significantly for the MAO Group at the end of the 2-y trial. There were no significant between-group differences in any of the self-care behaviors. |
| Sigurdardottir et al[18] (2009) Iceland | 28/25 | I = 57.8 (10.9) C = 63.5 (9.3) | I = 9.7 (6.6) C = 7.6 (5.6) | I: Based on an empowerment approach, 1 individual session at baseline and telephone calls once a wk for the 5 following wk. C: Routine diabetes care/6 wk | HbA1c, BMI Diabetes Knowledge Test DES, PAID t0: Baseline t1: Follow-up, 3 mo t2: Follow-up, 6 mo | No statistically significant differences between groups were found in HbA1c, BMI, scores for empowerment, well-being and distress. |
| Spencer et al[15] (2011) USA | 72/92 | I = 50 (10.8) C = 55 (9.8) | I = 8 (6.5) C = 9 (9.8) | I: Using an empowerment-based approach, community health workers provided participants with diabetes self-management education and regular home visits, and accompanied them to a clinic visit. C: routine care/6 mo | HbA1c, BMI, SBP, DBP, LDL PAID, self-efficacy t0: Baseline t1: Post, 6 mo | Participants in the intervention group had a mean HbA1c value of 8.6% at baseline, which improved to a value of 7.8% at 6 mo. There was no change in mean HbA1c among the control group (8.5%). |
| Mohamed et al[14] (2013) Qatar | 215/215 | I = 52 (8.9) C = 55 (10.7) | I = 11.5 (9.0) C = 10.3 (8.4) | I: The intervention consisted of four educational sessions for each group of patients (10–20 patients per session), lasting for 3–4 h, based on theory of empowerment. C: Routine care/not described | HbA1c, TC, SBP, DBP, HDL, LDL, BMI, TG KAP t0: Baseline t1: Follow-up, 12 mo | After 12 mo participation in the intervention was shown to have led to a statistically significant reduction in HbA1c, BMI and blood pressure. The intervention group also had improvement in Diabetes knowledge, attitude and practice. |
| Chen et al[9] (2015) China | 36/36 | I = 62.12 (7.51) C = 61.72 (8.79) | I = 8.12 (3.25) C = 7.45 (3.83) | I: 3-mo empowerment program, a 5-step MAGIC empowerment program was developed. C: Routine care/3 mo | HbA1c DES, DQOL Diabetes Self-care Scale t0: Baseline t1: Post, 3 mo t2: Follow-up, 6 mo | The experimental group had significantly decreased HbA1c and improved self-care behaviors, self-efficacy, and quality of life at 3 mo after the end of the intervention. |
| Ebrahimi et al[1] (2016) Iran | 53/53 | I = 46.97 (5.54) C = 48.15 (6.52) | <5 y (%): 28/30.2; 5–10 y (%): 51/52.8; >10 y (%): 21/17 | I: Empowerment approach training. C: Routine care/8 wk | HbA1c, TC, HDL, LDL, TG t0: Baseline t1: Post, 3 mo | HbA1c and other metabolic indicators except for LDL showed significant differences in the experimental group compared to the control group. |
| Cortez et al[11] (2017) Brazil | 127/111 | I = 58 (9.2) C = 57.5 (9.7) | not described | I: Empowerment program based on a behavior change protocol. C: routine care/12 mo | HbA1c, TC, SBP, DBP, HDL, LDL, BMI, TG t0: Baseline t1: Follow-up, 12 mo | Levels of HbA1c and other metabolic indicators showed a significant difference in the experimental group compared to the control group. |
| Macedo et al[13] (2017) Brazil | 72/111 | I = 60.4 (8.0) C = 57.5 (9.7) | ≤5 y (%): 38.9/18.9; >5 y (%): 61.1/81.1 | I: Empowerment approach, based on the Behavior Change Protocol. Seven group meetings, each one lasting around 2 h. C: routine care /6 mo | HbA1c DES-SF t0: Baseline t1: Post, 6 mo | A statistically significant decrease in the value of HbA1c and an increase in the score of empowerment scale were found for participants in the intervention group. |
| Cheng et al[17] (2019) China | 121/121 | I = 56.13 (10.72) C = 53.91 (13.01) | I = 8.15 (5.91) C = 7.79 (6.19) | I: A 6-wk empowerment-based self-management program, grounded on the principles of the Empowerment Process Model. C: routine care/6 wk | HbA1c Self-management behavior t0: Baseline t1: Follow-up, 5 mo | Compared with the attention control group, the intervention group showed a nonsignificant HbA1c reduction. |
| Varming et al[19] (2019) Denmark | 49/48 | I = 63 (11) C = 66 (9) | I = 16 (7) C = 17 (8) | I: Four one-on-one and 1 telephone consultations in which the EMMA tools were applied. EMMA builds on the 5step empowerment model of goal setting. C: routine care/not described | HbA1c, SBP, DBP, BMI PAID, SDSCA t0: Baseline t1: Post, 3 mo t2: Follow-up, 6 mo | The intervention was not superior to usual care in terms of glycemic control. |
BMI = body mass index, C = control group, DAS = Diabetes Attitude Scale, DBP = diastolic blood pressure, DCP = Diabetes Care Profile, DES = Diabetes Empowerment Scale, DQOL = Diabetes Quality of Life, DSMC = Diabetes Self-Management Competence Questionnaire, HDL = High density lipoprotein, I = intervention group, KAP = Knowledge, Attitude, Practice questionnaire, LDL = low-density lipoprotein, PAID = problem areas in diabetes scale, PHQ-9 = Patient Health Questionnaire, SBP = systolic blood pressure, SDSCA = Summary of Diabetes Self-Care Activities, TC = total cholesterol, TG = triglycerides.