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Diabetes: Self-Management Education In the Home – Children and Adolescents with Type 1 Diabetes - Inactive

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 3 studies (search period through December 2000). The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to diabetes prevention and control.

Context

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Summary of Results

Detailed results from the systematic review are available in the Task Force finding pdf icon [PDF - 134 kB].

The systematic review of self-management education interventions delivered in the home included three studies that addressed children and adolescents with type 1 diabetes and seven studies that involved adults with type 2 diabetes, gestational diabetes, or mixed type 1 and type 2 diabetes.

  • Glycated hemoglobin (GHb) levels decreased by a mean of 1.1 percentage points (95% CI: –1.6, –0.6) among those with Type 1 diabetes. This estimate is based on evidence from three studies of children and adolescents with type 1 diabetes and one study of adults with mixed type 1 and type 2 diabetes.

Summary of Economic Evidence

Detailed results from the systematic review are available in the Task Force finding pdf icon [PDF - 134 kB].

One study was found for diabetes self-management education in the home for adolescents with Type 1 diabetes.

  • The average program costs for the home intervention (adjusted to the Community Guide reference case) were $50 per child more than for traditional-care patients (a nonsignificant difference between groups).
  • Mean GHb levels were 10% lower for the home-care patients at 24 and 36 months after the intervention.

Applicability

This review should be applicable for children and adolescents of either gender with type 1 diabetes.

Evidence Gaps

Each Community Preventive Services Task Force (CPSTF) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the CPSTF finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the CPSTF recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the CPSTF recommendation is based.

Identified Evidence Gaps

The following outlines evidence gaps for self-management education interventions implemented in homes for children and adolescents with Type 1 diabetes and people with Type 2 diabetes.

  • The most effective components of DSME in the home, the optimal intensity and duration of the interventions, and the best person to deliver these interventions all need to be identified.
  • The effectiveness of these interventions as measured by intermediate outcomes (including changes in diet and physical activity, social support, and self-efficacy), health outcomes (including weight, lipid levels, and blood pressure), and quality of life needs to be determined.
  • Whether educating the person with diabetes in the home has health benefits for the family also needs to be examined.
  • Additionally, the effectiveness of these interventions among adults with Type 2 diabetes, particularly the elderly (65 years), should be addressed.
  • The effectiveness of these interventions in various racial and socioeconomic groups needs to be determined, as these data are rarely reported in this literature.
  • Perceived barriers to implementing DSME in the home also need to be identified, as does the best way to identify people who would benefit from an intervention in the home.
  • Finally, how these interventions are best linked to primary care and to disease management strategies needs to be determined.

Study Characteristics

Following are characteristics of the three studies that included children and adolescents with type 1 diabetes:

  • Studies were conducted in the U.S., Canada, and Australia.
  • Measured outcomes included knowledge, self-concept, healthcare utilization, and GHb levels.

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