Mula Tarigan (587060010-3)

Self-management Program for People with Diabetes Mellitus Type 2

1. Background

Diabetes mellitus (DM) is a global health problem, which 415 million people with diabetes in
2015 and estimated increase become 642 million in 2040 (IDF, 2015), and has effects on
individuals’ health, the health care system, and the economy of the world (Blair, 2003).

People with diabetes spend three hours a year with a healthcare professional on average. For
the remaining 8,757 hours they have to manage this complicated condition themselves
(Diabetes-UK, n.d.). Therefore, successful control of diabetes depends upon daily maintenance
with 95% of diabetes care estimated to be undertaken by the patient (Henderson, Wilson,
Roberts, Munt, & Crotty, 2014). In order to be able to manage their condition, the people with
diabetes must understand several important things by themselves. According to the American
Diabetes Association (ADA), people with diabetes should receive diabetes self-management
(ADA, 2015), because evidence supports the effectiveness of self-management in type 2
diabetes (Norris, Engelgau, & Venkat Narayan, 2001).

Self-management defined as the actions and decisions an individual makes to manage their
illness on a daily basis (Henderson et al., 2014). However, self-management has many
synonym in the literature such as ‘self-care’, ‘self-care activities’, and ‘self-care behaviors’
(Bagnasco et al., 2014). The International Diabetes Federation (IDF) quantified two sort of
self-management, they are diabetes self-management education (DSME) and diabetes self-
management support (DSMS) (Haas et al., 2014). DSME and DSMS are the ongoing processes
of facilitating the knowledge, skill, and ability necessary for diabetes self-care. The overall
objectives of DSME and DSMS are to support informed decision making, self-care behaviors,
problem solving, and active collaboration with the health care team to improve clinical
outcomes, health status, and quality of life (ADA, 2015).

Quality of life is an important health outcome in its own right, representing the ultimate goal
of all health interventions. Quality of life is measured as physical and social functioning, and
perceived physical and mental well-being. People with diabetes have a worse quality of life
than people with no chronic illness, but a better quality of life than people with most other
serious chronic diseases (Rubin & Peyrot, 1999).

The effectiveness of diabetes self-management on quality of life still need to be investigated

for several reasons. Some review studies affirmed self-management improved quality of life
diabetes patients. A systematic review of randomized controlled trials conducted by Norris et
Mula Tarigan (587060010-3)

al., 2001, stated even though evidence supports the effectiveness of self-management training
in type 2 diabetes, particularly in the short term, further research is needed to assess the
effectiveness of self-management interventions on quality of life. The reason is that the result
of this study show, on one hand, a study noted there was an increase quality of life at 18 months
for an intervention subgroup that received intensive counseling on both diet and physical
activity. On the other hand, two studies of brief interventions failed to demonstrate improved
quality of life. According to Zhang, Norris, Chowdhury, Gregg, & Zhang, (2007), a variety of
interventions can improve HRQL among adults with diabetes, but the magnitude of effects
varied with the interventions. Therefore, the mechanism of these changes needs to be examined
further. Cochran & Conn, (2010) found people with diabetes experience improved QOL from
participation in diabetes self-management training programs. However, future diabetes self-
management intervention studies should include quality of life outcomes so that this important
outcome can be further studied.

In contrast, a study was carried out in the outpatient clinic of a municipal hospital in Taipei
show that, the self-management intervention on health-related quality of life and depression
were not significantly different (Wu et al., 2011). A computer-based diabetes self-management
interventions do not appear to be effective in improving depression, quality of life, or weight
(Pal et al., 2014).

2. The review objective

The objective of the review is to describe the self-management program for adult people with
diabetes mellitus type 2.

3. The inclusion and exclusion criteria for studies in the review

The inclusion criteria for the articles was that they should be published in journals between
January 2006 and October 2016, should be related to self-management of type 2 diabetes,
should be adult men and women patients, should use quantitative methods and should be
available in English language.

4. The search strategy

The following electronic databases were searched: CINAHL, Proquest, and PubMed, between
the year 2006 and 2016 (10 years back in time). References of all retrieved articles were
checked for relevant studies. The search key words on CINAHL and Proquest were “diabetes
type 2”, “self-management program”, “self-management programme”, “self-management
intervention”, “self-management strategy”, “self-management support”, “self-management
education”, and “quality of life”, whereas, key words on PubMed were “type 2 diabetes
mellitus”, “self management program”, and “quality of life”. The electronic search and process
illustrated in figure 1.
Mula Tarigan (587060010-3)

Literature search: CINAHL, Proquest, and PubMed

• Diabetes type 2
• Self-management program
Identification

• Self-management programme
• Self-management intervention
• Self-management strategy
• Self-management support
• Self-management education
• Quality of life

CINAHL = 765
PubMed = 62
Proquest = 28
Screening

Total = 855 titles

Articles excluded from review (n=774)
Reasons:
- Duplicated
81 titles - No full text articles

Articles excluded from review (n=)

Reasons:
- Did not met inclusion criteria
30 articles

Articles excluded from review (n=)

Eligibility

Reasons:
- No data about quality of life

15 eligible articles

Articles excluded from review (n=)

Reasons:
- Data collection not clear
- Quality of life correlation was tested
with HbA1c, instead of self-
Included

management.

Total: 13 included articles

Figure 1. Process of the selection involving articles published between January 2006–October 2016.
Mula Tarigan (587060010-3)

5. Result
The result of the search strategy led to the identification of 13 relevant articles and the selected
literature briefly summarizes in table 1.

Table 1. Systematic review summary of self-management of people with type 2 diabetes.

- Author & year Intervention Scale Results

- Sample characteristics
- (Cani, Lopes, Queiroz, - An individualized pharmacotherapeutic care - Validated Brazilian - CG and IG was statistically
& Nery, 2015). plan (PCP). version of Diabetes significant different
- n = 70. - A diabetes education protocol. Quality of Life (p<0.001).
CG=36; IG=34. Measure.
- 6-month follow-up period

- (García, Brown, Horner, - Symptom-based diabetes self-management - The Diabetes-39. - Significant improvement in
Zuñiga, & Arheart, education program. total quality of life.
2014). - Food demonstrations.
- n = 72.
CG=33; IG=39. - Baseline; 2 months; 6 months.

- (Glasgow et al., 2006). - The CD-ROM of Chronic Care Model self- - Revised Diabetes - There were no significant
- n = 335. management framework program. Distress Scale. different (p=0.29).
CG=161; IG=174.
- Baseline; 2 weeks.

- (Glasgow et al., 2012). - Computer-assisted self-management (CASM). - The Diabetes - Improved in quality of life
- n = 463. - CASM program with the addition of enhanced Distress Scale across the 12 months, with
social support (CASM+). (DDS). generally larger effect sizes
- Enhanced usual care (EUC). at 4 months than at the 12
months.
- Baseline; 4 months; 12 months.

- (Jaipakdee, - Diabetic educational about the disease process. - Diabetes Quality of - Over six months, quality of
Jiamjarasrangsi, - Skill learning to manage their condition and Life. life was significantly
Lohsoonthorn, & change their lifestyle. improved.
Lertmaharit, 2015).
- n = 403. - Baseline; 3 months; 6 months.
CG= 200; IG= 203

- (Khunti et al., 2012). - The structured group education programme. - World Health - No difference was seen
- n = 824. Organization's between the groups for
CG= 387; IG= 437. - A three-years follow-up. quality of life quality of life at three years.
instrument
(WHOQOL-BREF).

- (Molsted, Tribler, - The education intervention. - The Danish Health - Significant improvements
Poulsen, & Snorgaard, and Morbidity were found in terms of
2012). - Time for intervention available elsewhere. Survey 2000 quality of life.
- n = 702. Questionnaire.

- (Moriyama et al., 2009). - Education program. - Two items from the - The quality of life was
- N = 65. overall QOL scale in improved significantly.
CG= 23; IG= 42. - Baseline; 3 months; 6 months; 9 months; 12 the WHO-QOL26,
months. created by the WHO
and translated into
Japanese.
Mula Tarigan (587060010-3)

- (Steed, Barnard, Hurel, - The University College London – Diabetes - The Audit of - The intervention had a
Jenkins, & Newman, Self-Management Programme (UCL-DSMP). Diabetes-Dependent significant impact on quality
2014). Quality of Life of life at all time points.
- n = 124. - Baseline; 1 week; 3 months; 6 months. measure.
CG= 59; IG= 65.

- (Tang, Funnell, - The Lifelong Management (LM) intervention. - Diabetes Distress - 6-month: no changes were
Noorulla, Oh, & Brown, Scale (DDS). found for diabetes-specific
2012). - Baseline; 6 months; 24 months. quality of life.
- n = 60. - 24-month: a significant
improvement for diabetes-
specific QOL.

- (Tang, Funnell, & Oh, - The Lifelong Diabetes Self-Management - The Diabetes - 1-Year follow-up period: no
2012). Intervention. Distress Scale. changes was found for
- n = 25. diabetes-specific quality of
- 24 months; 36 months. life.

- 2-Year intervention: a
significant improvement was
found for diabetes-specific
quality of life.

- (van Dijk-de Vries et al., - Integrate the self-management support (SMS) - The 12-item Short- - There was a dilution of the
2015). into routine care practice. Form Health Survey contrast between
- n = 264. (SF-12) measured intervention and control
CG= 147; IG= 117. - Baseline; 4months; 12 months. the quality of life. patients.

- (Wattana, Srisuphan, - The diabetes self-management program. - SF-36 Thai version 2 - A significant difference,
Pothiban, & Upchurch, survey for QOL. with the experimental
2007). - Baseline; 6 month. group’s participants
- n = 147. achieving a greater increase
CG= 72; IG= 75. in QOL than those in the
control group.

6. Discussion
Mula Tarigan (587060010-3)

Table 1. Systematic review summary of self-management of people with type 2 diabetes.

- Author & year Intervention Scale Results

- Sample characteristics
- (Cani, Lopes, Queiroz, - An individualized pharmacotherapeutic care - Validated Brazilian - CG and IG was statistically
& Nery, 2015). plan (PCP). version of Diabetes significant different
- n = 70. - A diabetes education protocol. Quality of Life (p<0.001).
CG=36; IG=34. Measure.
- 6-month follow-up period

- (García, Brown, Horner, - Symptom-based diabetes self-management - The Diabetes-39. - Significant improvement in
Zuñiga, & Arheart, education program. total quality of life.
2014). - Food demonstrations.
- n = 72.
CG=33; IG=39. - Baseline; 2 months; 6 months.

- (Glasgow et al., 2006). - The CD-ROM of Chronic Care Model self- - Revised Diabetes - There were no significant
- n = 335. management framework program. Distress Scale. different (p=0.29).
CG=161; IG=174.
- Baseline; 2 weeks.

- (Glasgow et al., 2012). - Computer-assisted self-management (CASM). - The Diabetes - Improved in quality of life
- n = 463. - CASM program with the addition of enhanced Distress Scale across the 12 months, with
social support (CASM+). (DDS). generally larger effect sizes
- Enhanced usual care (EUC). at 4 months than at the 12
months.
- Baseline; 4 months; 12 months.

- (Jaipakdee, - Diabetic educational about the disease process. - Diabetes Quality of - Over six months, quality of
Jiamjarasrangsi, - Skill learning to manage their condition and Life. life was significantly
Lohsoonthorn, & change their lifestyle. improved.
Lertmaharit, 2015).
- n = 403. - Baseline; 3 months; 6 months.
CG= 200; IG= 203

- (Khunti et al., 2012). - The structured group education programme. - World Health - No difference was seen
- n = 824. Organization's between the groups for
CG= 387; IG= 437. - A three-years follow-up. quality of life quality of life at three years.
instrument
(WHOQOL-BREF).

- (Molsted, Tribler, - The education intervention. - The Danish Health - Significant improvements
Poulsen, & Snorgaard, and Morbidity were found in terms of
2012). - Time for intervention available elsewhere. Survey 2000 quality of life.
- n = 702. Questionnaire.

- (Moriyama et al., 2009). - Education program. - Two items from the - The quality of life was
- N = 65. overall QOL scale in improved significantly.
CG= 23; IG= 42. - Baseline; 3 months; 6 months; 9 months; 12 the WHO-QOL26,
months. created by the WHO
and translated into
Japanese.

- (Steed, Barnard, Hurel, - The University College London – Diabetes - The Audit of - The intervention had a
Jenkins, & Newman, Self-Management Programme (UCL-DSMP). Diabetes-Dependent significant impact on quality
2014). Quality of Life of life at all time points.
- n = 124. - Baseline; 1 week; 3 months; 6 months. measure.
CG= 59; IG= 65.
Mula Tarigan (587060010-3)

- (Tang, Funnell, - The Lifelong Management (LM) intervention. - Diabetes Distress - 6-month: no changes were
Noorulla, Oh, & Brown, Scale (DDS). found for diabetes-specific
2012). - Baseline; 6 months; 24 months. quality of life.
- n = 60. - 24-month: a significant
improvement for diabetes-
specific QOL.

- (Tang, Funnell, & Oh, - The Lifelong Diabetes Self-Management - The Diabetes - 1-Year follow-up period: no
2012). Intervention. Distress Scale. changes was found for
- n = 25. diabetes-specific quality of
- 24 months; 36 months. life.

- 2-Year intervention: a
significant improvement was
found for diabetes-specific
quality of life.

- (van Dijk-de Vries et al., - Integrate the self-management support (SMS) - The 12-item Short- - There was a dilution of the
2015). into routine care practice. Form Health Survey contrast between
- n = 264. (SF-12) measured intervention and control
CG= 147; IG= 117. - Baseline; 4months; 12 months. the quality of life. patients.

- (Wattana, Srisuphan, - The diabetes self-management program. - SF-36 Thai version 2 - A significant difference,
Pothiban, & Upchurch, survey for QOL. with the experimental
2007). - Baseline; 6 month. group’s participants
- n = 147. achieving a greater increase
CG= 72; IG= 75. in QOL than those in the
control group.
Mula Tarigan (587060010-3)

Literature search: CINAHL, Proquest, and PubMed

• Diabetes type 2
• Self-management program
Identification

• Self-management programme
• Self-management intervention
• Self-management strategy
• Self-management support 7. Apprising the
• Self-management education
quality of articles
• Quality of life
8. Data
extraction
CINAHL = 765
9.
PubMed = 62
Proquest = 28
Screening

Total = 855 titles

Articles excluded from review (n=774)
Reasons:
- Duplicated
81 titles - No full text articles

Articles excluded from review (n=)

Reasons:
- Did not met inclusion criteria
30 articles

Articles excluded from review (n=)

Eligibility

Reasons:
- No data about quality of life

15 eligible articles

Articles excluded from review (n=)

Reasons:
- Data collection not clear
- Quality of life correlation was tested
with HbA1c, instead of self-
Included

management.

Total: 13 included articles

Mula Tarigan (587060010-3)
Mula Tarigan (587060010-3)

References

ADA. (2015). Standards of Medical Care in Diabetes - 2015. Diabetes Care, 38(Suppl. 1).
Bagnasco, A., Di Giacomo, P., Da Rin Della Mora, R., Catania, G., Turci, C., Rocco, G., &
Sasso, L. (2014). Factors influencing self-management in patients with type 2 diabetes: A
quantitative systematic review protocol. Journal of Advanced Nursing, 70(1), 187–200.
Blair, M. (2003). Diabetes Mellitus Review. Urologic Nursing, 36(1), 27–36.
Cochran, J., & Conn, V. S. (2010). Meta-Analysis of Quality of Life Outcomes Following
Diabetes Self-Management Training. Diabetes Education, 34(5), 815–823.
http://doi.org/10.1177/0145721708323640.META-ANALYSIS
Diabetes-UK. (n.d.). Diabetes self-management education: A healthcare professional resource.
Glasgow, R. E., Kurz, D., King, D., Dickman, J. M., Faber, A. J., Halterman, E., … Ritzwoller,
D. (2012). Twelve-month outcomes of an Internet-based diabetes self-management support
program. Patient Education and Counseling, 87(1), 81–92.
Haas, L., Maryniuk, M., Beck, J., Cox, C. E., Duker, P., Edwards, L., … 2012 Standards
Revision Task Force. (2014). National standards for diabetes self-management education
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Henderson, J., Wilson, C., Roberts, L., Munt, R., & Crotty, M. (2014). Social barriers to Type 2
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http://doi.org/10.1111/nin.12073
IDF. (2015). Diabetes Atlas. International Diabetes Federation.
Norris, S. L., Engelgau, M. M., & Venkat Narayan, K. M. (2001). Effectiveness of self-
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Pal, K., Eastwood, S. V., Michie, S., Farmer, A., Barnard, M. L., Peacock, R., … Murray, E.
(2014). Computer-based interventions to improve self-management in adults with type 2
diabetes: A systematic review and meta-analysis. Diabetes Care, 37(6), 1759–1766.
http://doi.org/10.2337/dc13-1386
Rubin, R. R., & Peyrot, M. (1999). Quality of life and diabetes. Diabetes/Metabolism Research
and Reviews, 15(3), 205–218.
Wu, S.-F. V., Liang, S.-Y., Wang, T.-J., Chen, M.-H., Jian, Y.-M., & Cheng, K.-C. (2011). A
self-management intervention to improve quality of life and psychosocial impact for people
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http://doi.org/10.1111/j.1365-2702.2010.03694.x
Zhang, X., Norris, S. L., Chowdhury, F. M., Gregg, E. W., & Zhang, P. (2007). The effects of
interventions on health-related quality of life among persons with diabetes: a systematic
review. Medical Care, 45(9), 820–34. http://doi.org/10.1097/MLR.0b013e3180618b55