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Lookup NU author(s): Dr Fiona CampbellORCiD
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Abstract Objective: Diabetes self-management education (DSME) is an approach to the management of diabetes that equips people with type 1 diabetes (T1D) with the skills they need to monitor and control their own blood glucose levels (HbA1c) by using insulin flexibly. It can result in improved blood glucose levels with reduced risk of hypoglycaemia. However, many struggle to sustain the improvements over time. To inform the design of more effective follow-up support we undertook a systematic review to identify what types of follow-up after this type of education programme is most effective in supporting sustaining improvements in glycaemic control. Methods: We undertook a systematic review of relevant RCTs, identified following a systematic search of 10 electronic databases. Studies evaluating a DSME programme delivered to participants with T1D which incorporated training in flexible intensive insulin therapy were included. Where there were sufficient homogenous studies data were pooled in meta-analyses. Where there was a lack of homogeneity in the included studies, a narrative synthesis was undertaken Findings: The search identified 13 trials delivering FIIT with a follow-up support component. The types of follow-up support were categorised as those that were educational (n=4), psychological (n=5) and ones that used technological support (n=4). All of the studies included a minimum of evaluation at 6 months following the end of the intervention. A number of features of follow-up support were identified to enhance the effectiveness of the DSME in terms of sustained effects on improved glycaemic control. These included: Educational interventions that are followed up by structured support and contact from the specialist diabetes team who delivered the education Support for a minimum of six months Support incorporating both group and individual follow-up (HbA1c -0.90%) Support Incorporating the use of mobile technologies that support the technical aspect of self-management and enable feedback (HbA1c -0.69%) Support incorporating CBT (HbA1c -0.90%) Support that Involves an individual’s social support network (HbA1c -0.90%) Conclusions: While this review is drawing on a limited evidence base, and measurement of outcomes only at a maximum of 2 years following the end of the intervention, it does suggest that the design and delivery of follow-up support can influence the effectiveness of DSME.
Author(s): Campbell F, Cooke D, Dracup N, Cantrell A, Hopkins D, Heller S
Publication type: Article
Publication status: Submitted
Journal:
Year: 2025
