97b45b3c50df20292bd4cc58ac418b01 pmc_10742682.pdf 8027e998dbce1e56144d9327446fb2a924c4f8dc pmc_10742682.pdf 63d2d06e262c151ec2310ab753bd3274eaee70b75b40ffd93106864f299f6d8f pmc_10742682.pdf Title: Self-Management Interventions for Adults Living with Type II Diabetes to Improve Patient-Important Outcomes: An Evidence Map Subject: Self-management interventions (SMIs) may be promising in the treatment of Diabetes Mellitus Type 2 (T2DM). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study summarizes intervention components and characteristics in randomized controlled trials (RCTs) related to T2DM using a taxonomy for SMIs as a framework and identifies components that are insufficiently incorporated into the design of the intervention or insufficiently reported. Following evidence mapping methodology, we searched MEDLINE, CINAHL, Embase, Cochrane, and PsycINFO from 2010 to 2018 for randomized controlled trials (RCTs) on SMIs for T2DM. We used the terms ‘self-management’, ‘adult’ and ‘T2DM’ for content. For data extraction, we used an online platform based on the taxonomy for SMIs. Two independent reviewers assessed eligible references; one reviewer extracted data, and a second checked accuracy. We identified 665 RCTs for SMIs (34% US, 21% Europe) including 164,437 (median 123, range 10–14,559) adults with T2DM. SMIs highly differed in design and content, and characteristics such as mode of delivery, intensity, location and providers involved were poorly described. The majority of interventions aimed to improve clinical outcomes like HbA1c (83%), weight (53%), lipid profile (45%) or blood pressure (42%); 27% (also) targeted quality of life. Improved knowledge, health literacy, patient activation or satisfaction with care were hardly used as outcomes (<16%). SMIs most often used education (98%), self-monitoring (56%), goal-setting (48%) and skills training (42%) to improve outcomes. Management of emotions (17%) and shared decision-making (5%) were almost never mentioned. Although diabetes is highly prevalent in some minority groups, in only 13% of the SMIs, these groups were included. Our findings highlight the large heterogeneity that exists in the design of SMIs for T2DM and the way studies are reported, making accurate comparisons of their relative effectiveness challenging. In addition, SMIs pay limited attention to outcomes other than clinical, despite the importance attached to these outcomes by patients. More standardized and streamlined research is needed to better understand the effectiveness and cost-effectiveness of SMIs of T2DM and benefit patient care. Keywords: diabetes type 2; self-management interventions; evidence mapping; quality improvement Author: Yang Song, Jessica Beltran Puerta, Melixa Medina-Aedo, Carlos Canelo-Aybar, Claudia Valli, Marta Ballester, Claudio Rocha, Montserrat León Garcia, Karla Salas-Gama, Chrysoula Kaloteraki, Marilina Santero, Ena Niño de Guzmán, Cristina Spoiala, Pema Gurung, Fabienne Willemen, Iza Cools, Julia Bleeker, Rune Poortvliet, Tajda Laure, Marieke van der Gaag, Kevin Pacheco-Barrios, Jessica Zafra-Tanaka, Dimitris Mavridis, Areti Angeliki Veroniki, Stella Zevgiti, Georgios Seitidis, Pablo Alonso-Coello, Oliver Groene, Ana Isabel González-González, Rosa Sunol, Carola Orrego and Monique Heijmans Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Wed Dec 13 04:15:05 2023 CET ModDate: Wed Dec 13 04:19:04 2023 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 21 Encrypted: no Page size: 595.276 x 841.89 pts (A4) 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02:42:42 CEST RepresentationInformation: pmc_10742682.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-04-24 02:38:30 CEST Size: 2323534 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 500 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Literature Search Destination: subsection.2.1 Item: Title: Screening and Selection Process Destination: subsection.2.2 Item: Title: Data Extraction and Collection Destination: subsection.2.3 Item: Title: Data Analysis Destination: subsection.2.4 Item: Title: Results Destination: section.3 Children: Item: Title: Search Results Destination: subsection.3.1 Item: Title: Key Characteristics of Included RCTs Destination: subsection.3.2 Item: Title: Characteristics of the Participants Destination: subsection.3.3 Item: Title: Characteristics of the SMIs Reported Destination: subsection.3.4 Children: Item: Title: Self-Management Support Techniques Destination: subsubsection.3.4.1 Item: Title: Expected Self-Management Behaviors Destination: subsubsection.3.4.2 Item: Title: Mode of Delivery Destination: subsubsection.3.4.3 Item: Title: Outcomes Reported in the Included RCTs Destination: subsection.3.5 Item: Title: Risk of Bias of the Included Studies Destination: subsection.3.6 Item: Title: Discussion Destination: section.4 Children: Item: Title: Main Findings Destination: subsection.4.1 Item: Title: Study Findings in the Context of Other Research Destination: subsection.4.2 Item: Title: Limitations and Strengths of This Study Destination: subsection.4.3 Item: Title: Implication for Practice and Research Destination: subsection.4.4 Item: Title: Conclusions Destination: section.5 Item: Title: Appendix A Destination: section.A. Item: Title: Appendix B Destination: section.B. Item: Title: Appendix C Destination: section.C. Item: Title: References Destination: section.D. Info: Title: Self-Management Interventions for Adults Living with Type II Diabetes to Improve Patient-Important Outcomes: An Evidence Map Author: Yang Song, Jessica Beltran Puerta, Melixa Medina-Aedo, Carlos Canelo-Aybar, Claudia Valli, Marta Ballester, Claudio Rocha, Montserrat León Garcia, Karla Salas-Gama, Chrysoula Kaloteraki, Marilina Santero, Ena Niño de Guzmán, Cristina Spoiala, Pema Gurung, Fabienne Willemen, Iza Cools, Julia Bleeker, Rune Poortvliet, Tajda Laure, Marieke van der Gaag, Kevin Pacheco-Barrios, Jessica Zafra-Tanaka, Dimitris Mavridis, Areti Angeliki Veroniki, Stella Zevgiti, Georgios Seitidis, Pablo Alonso-Coello, Oliver Groene, Ana Isabel González-González, Rosa Sunol, Carola Orrego and Monique Heijmans Subject: Self-management interventions (SMIs) may be promising in the treatment of Diabetes Mellitus Type 2 (T2DM). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study summarizes intervention components and characteristics in randomized controlled trials (RCTs) related to T2DM using a taxonomy for SMIs as a framework and identifies components that are insufficiently incorporated into the design of the intervention or insufficiently reported. Following evidence mapping methodology, we searched MEDLINE, CINAHL, Embase, Cochrane, and PsycINFO from 2010 to 2018 for randomized controlled trials (RCTs) on SMIs for T2DM. We used the terms ‘self-management’, ‘adult’ and ‘T2DM’ for content. For data extraction, we used an online platform based on the taxonomy for SMIs. Two independent reviewers assessed eligible references; one reviewer extracted data, and a second checked accuracy. We identified 665 RCTs for SMIs (34% US, 21% Europe) including 164,437 (median 123, range 10 14,559) adults with T2DM. SMIs highly differed in design and content, and characteristics such as mode of delivery, intensity, location and providers involved were poorly described. The majority of interventions aimed to improve clinical outcomes like HbA1c (83%), weight (53%), lipid profile (45%) or blood pressure (42%); 27% (also) targeted quality of life. Improved knowledge, health literacy, patient activation or satisfaction with care were hardly used as outcomes (<16%). SMIs most often used education (98%), self-monitoring (56%), goal-setting (48%) and skills training (42%) to improve outcomes. Management of emotions (17%) and shared decision-making (5%) were almost never mentioned. Although diabetes is highly prevalent in some minority groups, in only 13% of the SMIs, these groups were included. Our findings highlight the large heterogeneity that exists in the design of SMIs for T2DM and the way studies are reported, making accurate comparisons of their relative effectiveness challenging. In addition, SMIs pay limited attention to outcomes other than clinical, despite the importance attached to these outcomes by patients. More standardized and streamlined research is needed to better understand the effectiveness and cost-effectiveness of SMIs of T2DM and benefit patient care. 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