Study |
Selected Inclusion/ Exclusion Criteria |
Study Design |
Patients |
Interventions |
Treatment Duration |
Outcomes/Results |
Comments |
#5220
Agurs-Collins, Kumanyika, Ten Have & Adams-Campbell, 1997
|
Include: African-American, diagnosed NIDDM,=55 years old,=120% of Metropolitan weight standards, HbA1c=8%
Exclude: nonambulatory, medical contraindications to program participation
|
RCT with 2 treatment conditions:
1) Usual care.
2) Intervention.
|
N=64
n uc=32
n int=32
*9 did not complete the program (7 from control, 2 from intervention).
Age means (SD):
uc=61(5.7)
int=62.4(5.9)
Age range: 55-79
% Female:
uc: 88
int: 66
Race % not given
Baseline HbA1c means (SD):
Intention to treat:
uc: 10.0 (1.9)
int: 11.0 (1.7)
|
1) Usual care.
2) Intervention—program was age and culture appropriate for pop. Encouraged adherence to a healthy diet, moderate physical activity at least 3 times a week. In the first 3 months, 12 weekly group sessions were held for an hour with a 30 min discussion on nutrition education and then a 30 min exercise session in the physical therapy area of the clinic. One individual diet counseling session during this pd. The next 3 months consisted of 6 bi-weekly (90 min) group sessions providing additional information and support, with sharing, problem solving. Each participant also received an individualized weight reduction diet. The behavioral component included topics such as relapse prevention and weight maintenance, goal setting, controlling triggers to eat and portion control. Participants were asked to keep food and exercise diaries. Spouses were encouraged to come to the interventions as well.
|
6 months. Assessments made at 0, 3, and 6 mos.
|
Completer Results:
1) Metabolic control:
a) HbA1c % means (SD):
uc: 10.0 (1.9) base
10.3 (1.9) 3 mo
11.5 (4.4) 6 mo
int: 11.0 (1.7) base
9.5 (1.8) 3 mo
9.9 (2.0) 6 mo
*Reported a significant between group difference in HbA1c at 3- and 6-months (p<0.01). Statistical test not given.
2) Measures of risk:
a) Weight (kg) means (SD):
uc: 94.9 (20.1) base
96.2 (21.2) 3 mo
96.9 (21.6) 6 mo
int: 93.3 (18.6) base
90.8 (20.3) 3 mo
90.7 (20.1) 6 mo
*Reported a significant between group difference in weight at 3- and 6-months (p<0.01). Statistical test not given.
b) Systolic blood pressure-SBP means (SD):
uc: 139 (14) base
148 (24) 3 mo
147 (22) 6 mo
int: 144 (17) base
144 (21) 3 mo
146 (21) 6 mo
*Reported no significant differences in SBP between groups at 3 and 6 mo. Statistical test not given.
c) Diastolic blood pressure-DBP means (SD):
uc: 77 (10) base
79 (8) 3 mo
80 (10) 6 mo
int: 79 (10) base
78 (10) 3 mo
79 (9) 6 mo
*Reported no significant differences in DBP between groups at 3 and 6 mo. Statistical test not given. (p<0.05 at 6-months)
d) HDL Cholesterol means (SD):
uc: 52.6 (15) base
50.9 (12.9) 3 mo
51.9 (14.2) 6 mo
int: 49.2 (9.9) base
46.1 (8.1) 3 mo
46.8 (10.8) 6 mo
*Reported no significant decrease in HDL for both groups at 3 and 6 mo. Statistical test not given.
e) LDL Cholesterol means (SD):
uc: 156.0 (47.9) base
150.1 (27.8) 3 mo
154.6 (30.7) 6 mo
int: 171.9 (37) base
156.1 (32.8) 3 mo
162.4 (39.2) 6 mo
*Reported no significant decrease in LDL for both groups at 3 and 6 mo. Statistical test not given.
Events:
a) Health care utilization: Not given
b) Morbidity/mortality: Not given
|
Quality Assessment:
Internal Validity:
Described as randomized? Yes
Method of randomization clearly described? Yes
Concealment of allocation? No
Described as double-blind? No
Patient blinded? No
Investigators blinded? No
Outcome assessors blinded? No
No. of withdrawals in each group stated? Yes
External Validity:
Pop. Described? Yes
Intervention described well enough to reproduce? Yes
Intervention codified in manual? Yes
Provider training described? Yes
Patients assessed for DSM dx? No
Biases, etc: None Noted
|
#460
Aikens, Kiolbasa, Sobel, 1997
|
Include: NIDDM=1 year
Exclude: comorbid medical conditions affecting metabolic or neuroendocrine function; gross medical noncompliance
|
RCT- single-center design with 2 groups:
1) Control.
2) Relaxation training (tx).
|
N=22
n control=10
n tx=12
*No drop-outs
Age mean (SD): 61 (10.2)
Age range=33-83
59% Female
Race %:
59-African Amer.
32-Caucasian
5-Hispanic
5-Asian
Baseline GHb % means (SD):
Completers:
control: 12.0 (1.7)
tx: 10.2 (1.9)
|
Relaxation group attended group sessions consisting of:
1) Rationale for the practice of relaxation.
2) General guidelines for encouraging relaxation and discussion of role of stress.
3) In-session therapist-guided instruction emphasizing progressive muscle relaxation.
4) Brief relaxing imagery component.
|
8-week intervention with followup at week 16 (f/u).
|
Completer Results:
1) Metabolic control:
a) GHb % means (SD):
control: 12.0 (1.7) base
11.3 (1.7) f/u
tx: 10.2 (1.9) base
10.2 (1.6) f/u
*ANCOVA indicated no significant effect of group on Week 16GHb.
b) Area under 2-hour oral- glucose-tolerance curve (AUC) means (SD):
control: 32,110 (9,002) base
33,965 (8,212) post
32,167 (7,212) f/u
tx: 33,493 (7,335) base
35,271 (6,286) post
35,408 (7,008) f/u
*ANOVA indicated no significant effect of group on Post and Week 16 AUC
2) Measures of risk: Not given
3) Events:
a) Health care utilization: Not given
b) Morbidity/mortality: Not given
4) Psychological Measures:
a) Generalized distress (General Severity Index-GSIa) means (SD):
con: 53.8 (11) base
55.6 (8.7) post
56.1(7.9) f/u
tx: 57.5 (10) base
51.4 (8.9) post
54.1 (12) f/u
*Significance not given
b) Anxiety Symptoms (Symptoms Checklist-90 Revised-SCL-90Ra) means (SD):
con: 46.6 (13.3) base
50.0 (11.2) post
52.1(11.1) f/u
tx: 52.5 (11.9) base
47.4 (8) post
49.8 (13.5) f/u
*Significance not given
c) Daily Stress (Daily Hasslesa) means (SD):
con: 24.3 (13.3) base
28.3 (16) post
29 (11) f/u
tx: 37.4(18.8) base
29.5(15.1) post
28.4(15.8) f/u
*Significance not given
|
Quality Assessment:
Internal Validity:
Described as randomized: Yes
Method of randomization clearly described? No
Concealment of allocation? No
Described as double-blind? No
Patient blinded? No
Investigators blinded? No
Outcome assessors blinded? No
No. withdrawals stated? Yes, none.
External Validity:
Pop. Described? Yes
Intervention described well enough to reproduce? Yes
Intervention codified in manual? Yes
Provider training described? No
Patients assessed for DSM dx? No
Biases, etc:
Investigators state that baseline GHb significantly different between groups, but did not use baseline measures as covariate; very small sample.
|
#2920
Anderson, Funnell, Butler, Arnold, Fitzgerald, & Feste, 1995
|
Include: type II diabetes
Exclude: not stated
|
RCT with 2 treatment conditions:
1) Intervention group (int).
2) Wait-list control group (wl).
|
N=64
*18 subjects were not randomized, 10 subjects dropped out (does not specify from which groups).
Age mean: 50
% Female: 70
Race % not given
Baseline GHb % means (sd):
Completers:
int: 11.75 (3.01) wl: 10.82 (2.94)
|
1) Intervention—6 weekly session patient empowerment education program: designed to enhance the ability of patients to identify and set realistic goals, to apply problemsolving processes to eliminated barriers, help cope with circumstances that cannot be changed, manage the stress caused by living with diabetes, obtain social support, and improve self-motivation.
2) Wait-list control—after the first six weeks, the control group completed the six-session empowerment program.
|
6-weeks, followup completed by both groups after 12-weeks.
|
Completer Results:
1) Metabolic control a) GHb % means (SD): int: 11.75 (3.01) base 11.02 (2.89) post wl: 10.82 (2.94) base 10.78 (2.59) post
*t-tests indicated a significantly greater reduction in int group compared to wl (p=0.05).
2) Measures of risk: Not given
3) Events:
a) Health care utilization: Not given
b) Morbidity/mortality: Not given
4) Psychological Measures: a) Self Efficacy mean Change Scoresb: -Assessing satisfaction: int: 0.29 base-post wl: -0.04 base-post *t-tests indicated no significant difference. Statistical test not given. -Setting goals: int: 0.69 base-post wl: -0.12 base-post *t-tests indicated a significant difference (p<0.001). Statistical test not given.
-Solving problems: int: 0.32 base-post wl: -0.02 base-post *t-tests indicated no significant difference. Statistical test not given.
-Emotional coping: int: 0.41 base-post wl: 0.12 base-post *Analysis indicated no significant difference. Statistical test not given.
-Managing stress: int: 0.29 base-post wl: 0.01 base-post *Analysis indicated a significant difference (p=0.05). Statistical test not given.
-Obtaining support: int: 0.36 base-post wl: -0.11 base-post *Analysis indicated a significant difference (p=0.002). Statistical test not given.
-Motivating oneself: int: 0.29 base-post wl: -0.09 base-post *Analysis indicated no significant difference. Statistical test not given.
-Making decisions: int: 0.47 base-post wl: 0.05 base-post *Analysis indicated a significant difference (p=0.02). Statistical test not given. |
Quality Assessment:
Internal Validity: Described as randomized? Yes Method of randomization clearly described? No Concealment of allocation? No Described as double-blind? No Patient blinded? No Investigators blinded? No Outcome assessors blinded? No No. of withdrawals in each group stated? Yes
External Validity: Pop. Described? Yes Intervention described well enough to reproduce? Yes Intervention codified in manual? No Provider training described? No Patients assessed for DSM dx? No Biases, etc: No measures of risk assessed; no statistical analyses reported. |
#840
Boehm,
Schlenk,
Raleigh,
Ronis, 1993 |
Include: Under
physician care for
Type II Diabetes, Age
=18 years
Exclude: non-English
literate |
RCT-multi center
design with 4 groups:
1) Attention control
(attention).
2) Compliance.
3) Behavioral
strategies (beh.
strat.).
4) Behavioral
strategies with
instruction (beh.
strat. w/ inst.). |
N=156
n attention=41
n compliance=32
n beh.strat.=42
n beh.strat w/inst.=41
*does not state # of
drop-outs
mean age (SD):
58 (11.3)
60% Female
Race % not given
Baseline GHb %:
Not given |
1) Attention—received routine care
& consistent followup
by clinical nurse.
2) Compliance—focused
on behaviors
directly related to
regimen.
3) Beh. strat.—behavioral analyses
sessions with nurse
that focused on one
of 4 strategies: self-monitoring,
stimulus
control, changing
behaviors in small
steps and self-resourcefulness.
4) Beh. strat. w/ inst.—behavioral analyses
with nurse & received
instruction about
strategies and
behavioral analysis. |
Ranged from
1.5-29 months.
mean treatment
period=12.8
months |
Completer Results:
1) Metabolic control: GHb (% change
mean (SD)):
attention: -4.98 (26.08) compliance: -5.02 (20.37)
beh. strat.: 1.73 (20.27)
beh. strat. w/inst.: 1.6 (25.93)
*t-tests indicated no significant
between-group differences
2) Measures of risk: Weight (%
change mean (SD)):
attention: 1.3 (6.97)
compliance: 0.47 (6.08)
beh. strat.: -1.52 (6.89) beh. strat. w/inst.: 1.54(8.71)
*t-tests indicated no significant
between-group differences
3) Events:
a) Health care utilization:
Not given
b) Morbidity/mortality:
Not given |
Quality Assessment:
Internal Validity:
Described as randomized: Yes
Method of randomization
clearly described? No
Concealment of allocation?
No
Described as double-blind?
No
Patient blinded? No
Investigators blinded? No
Outcome assessors blinded?
No
No. withdrawals stated? No
External Validity:
Pop. Described? Yes
Intervention described well
enough to reproduce? Yes
Intervention codified in
manual? No
Provider training described?
No
Patients assessed for DSM
dx? No
Biases, etc:
Large range in treatment
duration |
#3830
Brown,
Garcia,
Kouzekanani
& Hanis, 2002 |
Include: type II
diabetes, 35-70 years
old
Exclude: pregnant
women, medical
contraindications
*recruited from
Mexican-American
community in Texas. |
RCT with 2 treatment
conditions:
1) Experimental (exp).
2) 1-yr. Wait-listed
control group
receiving usual care
(wl). |
N=256
n exp=126
n wl=126
*4 patients did not
complete study
Age means (SD):
n exp=54.7(8.2)
n wl=53.3 (8.3)
Age range: 35-71
% Female:
exp=60
wl=68
Race % not given
Baseline HbA1c %
means (SD):
exp : 11.81 (3)
wl : 11.8 (3.02) |
1) 1-yr wait list
condition has
usual care.
2) Intervention—employed bilingual
Mexican American
nurses/dietitians.
Focused on
realistic health
recommendations
and showed
videos of
community
leaders discussing
their experiences
with diabetes.
Focused on
improving blood
glucose levels
rather than on
weight loss:
provided rapid,
frequent feedback;
promoted group
problem-solving;
involved support
from family and
friends. Taught
self-monitoring of
blood glucose,
exercise, problem-solving
and food
preparation
demonstrations. |
52 contact hours,
over 12 months.
Longitudinal
followup for up
to 3 years |
1) Metabolic control:
a) HbA1c % means (SD): exp: 11.81 (3.0) base
10.6 (2.64) 3 mo
10.8 (2.8) 6 mo
10.89 (2.56) 12 mo wl: 11.80 (3.02) base
11.22 (2.77) 3 mo
12.2 (2.95) 6 mo
11.64 (2.85) 12 mo
*ANCOVA indicated significant effect of
group on HbA1c at 6 mo (p<0.001) and
12 mo (p=0.011)
b) Fasting Blood Glucose-FBG
means (SD): exp: 213.01 (64.06) base
189.62 (66.97) 3 mo
185.24 (60.90) 6 mo
194.95 (63.27) 12 mo
wl: 207.12 (71.41) base
201.01 (62.16) 3 mo
215.04 (66.81) 6 mo
210.51 (66.55) 12 mo
*ANCOVA indicated significant effect of
group on FBG at 3 mo (p=0.038), 6 mo
(p<0.001) and 12 mo (p=0.019)
2) Measures of risk:
a) BMI means (SD):
exp: 32.33 (5.97) base
31.9 (6.05) 3 mo
31.7 (5.84) 6 mo
32.17 (6.45) 12 mo
wl: 32.12 (6.35) base
32.73 (6.84) 3 mo
32.47 (6.83) 6 mo
32.28 (6.52) 12 mo
*ANCOVA indicated no significant
effect of group on BMI.
b) Cholesterol means (SD): exp: 211.83 (45.34) base
191.39 (41.12) 3 mo
192.46 (40.34) 6 mo
189.88 (36.35) 12 mo
wl: 203.57 (6.35) base
187.93 (40.84) 3 mo
185.88 (40.53) 6 mo
187.64 (42.66) 12 mo
*ANCOVA indicated no significant
effect of group on Cholesterol at 3, 6
and 12 mo.
3) Events:
a) Health care utilization:
Not given
b) Morbidity/mortality:
Not given
|
Quality Assessment:
Internal Validity:
Described as randomized?
Yes
Method of randomization
clearly described? No
Concealment of allocation?
No
Described as double-blind?
No
Patient blinded? No
Investigators blinded? No
Outcome assessors blinded?
No
No. of withdrawals in each
group stated? Yes
External Validity:
Pop. Described? Yes
Intervention described well
enough to reproduce? Yes
Intervention codified in
manual? No
Provider training described?
Yes
Patients assessed for DSM
dx? No
Biases, etc:
F/u continued for 3 years, yet
did not report any longitudinal
findings beyond one year. |
# 1440
Cabrera-Pivaral,
Gondalez-Perez, Vega-Lopez, et al
2000 |
Include: Type II
diabetes
Exclude: Insulin
treatment |
RCT with 2 groups:
1) Diabetes education (con).
2) Behavior
modification (tx). |
N=49
n con=24
n tx=25
Age means (SD):
con: 57.8 (8.7)
tx: 58.1 (12.4)
% Female:
con: 54.2
tx: 48
Race % not given
Baseline Glucose
(mg/dl) means(SD):
Completers:
con: 221 (83)
tx: 210 (43) |
Behavior modifying
program consisted
of the development
of the patients'
natural skills and
abilities,
encouraging
communication and
the exchange of
ideas, and the use
of various
participation
techniques.
Program focused
on changing
thoughts, behaviors
and feelings.
Educational control
patients received
information about
nutrients, calories,
and metabolic
control. |
Weekly sessions
over 9 mo.
period. |
Completer Results:
1) Metabolic control:
-Glucose (mg/dl) means (SD): con: 221 (83) base 182 (48) final 3 mos. mean tx: 210 (43) base 147 (32) final 3 mos. mean
*Between group differences not given.
Statistical test not given.
2) Measures of risk:
-Total Cholesterol means (SD): con: 225 (39) base 222 (27) final 3 mos. mean tx: 230 (41) base 199 (21) final 3 mos. mean*
*Between group differences not given.
Statistical test not given.
3) Events:
a) Health care utilization:
Not given b) Morbidity/mortality:
Not given |
Quality Assessment:
Internal Validity:
Described as randomized?
Yes
Method of randomization
clearly described? No
Concealment of allocation?
No
Described as double-blind?
No
Patient blinded? No
Investigators blinded? No
Outcome assessors blinded?
No
No. of withdrawals in each
group stated? No
External Validity:
Pop. Described? Yes
Intervention described well
enough to reproduce? Yes
Intervention codified in
manual? No
Provider training described?
No
Patients assessed for DSM
dx? No
Biases, etc:
Statistical analyses not clearly
explained; between-group
results not reported |
#620
Campbell,
Redman,
Moffitt, et al.
1996 |
Include: diagnosed
with NIDDM <5 years;
age<80
Exclude: previous
formal instruction in
diabetes care; taking
over 75% of maximum
oral hypoglycemic
dosage; terminal
illness diagnosis |
RCT-single-center
design with 4 groups:
1) Minimal(min).
2) Individual education (ind).
3) Group education
(grp). 4) Behavioral
(beh). |
N=238
n min=59
n ind=57
n grp=66
n beh=56
*56 patients did not
complete study—ind:
23; grp: 28; beh: 5
Age means (SD):
min=58.2 (1.3)
ind=56.8 (1.5)
gr=58.4 (1.4)
beh=60.9 (1.4)
% Female:
min=63
ind=42
grp=47
beh=57
Race % not given
Baseline HbA1
means (SD):
Intended to treat:
min=11.9 (0.6)
ind=12.2 (0.5)
grp=12.1 (0.6)
beh=13.3 (0.6)
| 1) Min-2 sessions:
received minimal
information about
diet, exercise &
diabetic education.
2) Ind—individual
sessions plus 3 day
small group course:
focused on diet,
exercise & diabetic
education.
3) Grp—group
education sessions
with information
about diet, exercise &
diabetic education.
4) Beh—nurse-taught
cognitive-behavioral
strategies focused on
eating, exercise &
smoking in individual
visits=3.
| Ranged from 2
weeks to 12
months. |
Completer Results:
1) Metabolic control:
HbA1 (% change mean (SD)):
min=-3.5 (0.6) 3 mo -2.2 (0.8) 6 mo
ind=-3.4 (0.7) 3 mo -3.9 (0.6) 6 mo -3.3 (0.9) 12 mo grp=-3.8 (0.6) 3 mo -5 (0.9) 6 mo -3 (1.1) 12 mo beh=-4.7 (0.6) 3 mo
-4.7 (0.7) 6 mo
-4.8 (0.7) 12 mo
*ANCOVA indicated no significant
effect of group on HbA1c at 6 mo and
12 mo
2) Measures of risk:
a) BMI (% change mean (SD)):
min=-1.8 (0.3) 3 mo
-1.4 (0.4) 6 mo
ind=-1.9 (0.2) 3 mo
-2.2 (0.3) 6 mo
-2 (0.4) 12 mo
grp=-1.6 (0.2) 3 mo
-2.2 (0.3) 6 mo
-1.4 (0.5) 12 mo
beh=-2.1(0.2) 3 mo
-2.5 (0.4) 6 mo
-2.6 (0.5) 12 mo
*ANCOVA indicated no significant
effect of group on BMI at 6 mo and 12 mo
b) Systolic blood pressure (% change mean (SD)):
min=-3.4(3.5) 3 mo
-1.6(5.2) 6 mo
ind=-3.2(3.5) 3 mo
-7.5(4.8) 6 mo
-6.8(5.8) 12 mo
grp=-6.1(3.31) 3 mo
-4.0(4.9) 6 mo
-12.4(6.8) 12 mo
beh=-9.0(2.4) 3 mo
-11.2(3.2) 6 mo
-16.9(3.8) 12 mo
c) Diastolic blood pressure
(% change mean (SD)):
min=-4.9(1.4) 3 mo
1.1(2.2) 6 mo
ind=-4.1(1.8) 3 mo
-4.2(1.8) 6 mo
-5.3(3) 12 mo*
grp=-5.5(1.9) 3 mo
-3.3(2.4) 6 mo
-5.0(4) 12 mo*
beh=-9.1(1.8) 3 mo
-11.6(1.9) 6 mo
-7.9(2.6) 12 mo*
*ANCOVA indicated a significant
effect of group on Diastolic blood
pressure at 12 mo: p=.022
3) Events:
a) Health care utilization:
-Consulted Ophthalmologist (%) min=63 3 mo
79 6 mo
ind=67 3 mo
85 6 mo
97 12 mo
grp=50 3 mo
82 6 mo
95 12 mo
beh=57 3 mo
78 6 mo
89 12 mo
*Chi square indicated no significant
effect of group at 6 mo and 12 mo
-Consulted Podiatrist (%)
min=12 3 mo
27 6 mo
ind=10 3 mo
33 6 mo
55 12 mo
grp=21 3 mo
53 6 mo
73 12 mo
beh=43 3 mo
65 6 mo
74 12 mo
*Chi square indicated a significant
effect of group at 3 mo (p=.003) and 6
mo (p=.005)
b) Morbidity/mortality:
Not given
|
Quality Assessment:
Internal Validity:
Described as randomized: Yes
Method of randomization
clearly described? No
Concealment of allocation? No
Described as double-blind? No
Patient blinded? No
Investigators blinded? No
No. withdrawals stated? Yes
External Validity:
Pop. Described? Yes
Intervention described well
enough to reproduce? Yes
Intervention codified in
manual? No
Provider training described?
No
Patients assessed for DSM dx?
No
Biases, etc:
Different attrition rates across
groups: min=0% ind=40% by
mo grp=42% by 12 mo beh=9% by 12 mo;
investigators note no control
for provider |