Study |
Selected Inclusion/ Exclusion Criteria |
Study Design |
Patients |
Interventions |
Treatment Duration |
Outcomes/Results |
Comments |
#3400
Campbell,
Barth,
Gosper, Jupp,
Simons, &
Chisolm,
1990. |
Include: Randomized
effects of an intensive
educational approach
to dietary change in
NIDDM. |
RCT with 2 treatment
conditions:
1) Conventional
Intervention (con).
2) Intensive
intervention (int). |
N=70
n con=29
n del=33
*8 subjects dropped
out.
Age mean(SD):
con=59(9)
del=58(9)
% Female:
con=41.4
int=45.5
Race % not given
Baseline Fasting
Blood Glucose (mM)
means (SD): con: 8.9 (2.1)
del: 9.7 (2.8) |
1) Conventional
Program—covered topics of
explaining
diabetes, diabetes
complications, and
diet, exercise, and
food composition.
2) Intensive
program—
included longer,
more in-depth
sessions on diet,
podiatry,
cognitive-motivation
components,
unconscious and
conscious mental
processes
affecting the
desire to achieve
goals or take
action.
Participants
established
adequate reasons
for behavioral
change. Subjects
were asked to
visualize the
adverse effects of
diabetic
complications. |
Convention—3
consecutive
days.
Intensive—11
weeks (total 22
hrs)
Both had 1
month and 3
month followup |
1) Metabolic control -Fasting Blood Glucose (mM) means
(SD): con: 8.9 (2.1) base 9.2 (3.4) 1 mo 9.5 (3.4) 3 mo 8.3 (2.7) 6 mo del: 9.7 (2.8) base 9.4 (2.7) 1 mo 9.1 (3.0) 3 mo 9.6 (2.9) 6 mo
*RM-ANCOVA indicated no significant
differences in fasting blood glucose
between groups over time (=0.7).
2) Measures of risk:
a) Body Mass Index—BMI means
(SD): con: 32.0 (5.5) base 31.5 (5.6) 1 mo 31.2 (5.4) 3 mo 31.1 (5.1) 6 mo del: 30.4 (4.8) base 29.5 (4.7) 1 mo 29.6 (4.5) 3 mo 29.6 (4.6) 6 mo
*RM-ANCOVA indicated no significant
differences between groups over time
(p=0.28).
b) Total Cholesterol means (SD): con: 6.5 (1.1) base 6.5 (1.4) 1 mo 6.3 (1.2) 3 mo 6.5 (1.0) 6 mo del: 7.4 (1.2) base 6.6 (1.1) 1 mo 6.8 (1.1) 3 mo 6.6 (1.0) 6 mo
*RM-ANCOVA indicated a significant
difference between groups over time
(p=0.007).
c) HDL-Cholesterol means (SD): con: 1.2 (0.2) base 1.1 (0.2) 1 mo 1.2 (0.2) 3 mo 1.1 (0.2) 6 mo del: 1.1 (0.2) base 1.1 (0.2) 1 mo 1.2 (0.2) 3 mo 1.1 (0.3) 6 mo
*RM-ANCOVA indicated no significant
differences between groups over time
(p=0.27).
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?
No
Patients assessed for DSM
dx? No
Biases, etc:
None noted |
#6360
Cox, Gonder-Frederick,
Julian, Cryer,
Herrman,
Richards &
Clarke, 1991 |
Include: IDDM=2
years since diagnosis;
insulin usage since
diagnosis; using self-measurement
of blood
glucose
Exclude: history of
heart disease,
hypertension, seizure
activity, or severe
psychiatric
disturbance; chronic
medication other than
insulin |
RCT with 3 treatment
conditions:
1) Control (con).
2) Standard BGAT (sta).
3) Intensive BGAT (int). |
N=39
n con=14
n sta=13
n int=12
*withdrawals not
stated
Age means:
Intended to treat:
con=33.8
sta=33.7
int=31.1
% Female:
Intended to treat:
con=57.1
sta=61.5
int=66.7
Race % not given
Baseline HbA1
means:
Intended to treat:
Con=11.4
Sta=10.4
Int=12.8 |
1) Standard
BGAT—7 weekly
classes with
readings and
BGAT with
readings and
homework
exercises having
to do with BGAT
manual, BG
symptoms, how
insulin, food, and
exercise effects
BG. Daily
systematic
recordings of
internal and
external cues of
BG.
2) Intensive
BGAT—during
hospitalization,
subjects were
provided with
immediate BG
feedback while
hyper and
hypoglycemic. At
these times,
subjects described
their experiences
on audio tape,
rated perceived
symptoms on a
checklist,
estimated BG
level and then
were told actual
BG level. Patients
were later given the audio tape
and were allowed
to recall how they
felt when hyper- and
hypoglycemic.
3) Placebo control
group also attended
group meetings and
kept diaries
recording daily
stress factors and
diabetic self-care
behaviors. |
7-week
intervention
following
hospitalizations |
Completer Results:
1) Metabolic control: - HbA1 % means (SD): con: 11.1 (2.2) base 11.7 (2.6) post 11.3 (2.6) f/u sta: 10.5 (2.4) base 10.6 (2.6) post 10.1 (2.4) f/u int: 12.8 (4.1) base 12.1 (3.6) post 10.3 (2.7) f/u
*ANOVA indicated int significantly
different from con (p<0.02)
2) Measures of risk:
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? Yes
Provider training described?
No
Patients assessed for DSM
dx? No
Biases, etc:
None noted |
#6250
D'Eramo-Melkus,
Wylie-Rosett,
Hagen, 1991 |
Include: NIDDM, 21-65 years old, 20-75%
over desirable body
weight.
Exclude: Insulin
dependence, or
serious illness. |
RCT with 3 treatment
conditions:
1) Single individual
session (con).
2) 12-wk behavior
oriented diabetes
education and weight
control group
intervention (int.).
3) Group intervention
plus six individual
followup sessions (int
+ fu). |
N=82
n con=28
n int=28
n int+fu=26
*33 drop-outs (13 In
control, 13 in int, 7 in
int+fu)
Age mean (SD):
55.6 (8.05)
% Female: 58.5
Race % not given
Baseline HbA1 %
means (SD):
Completers: con=10.91(2.6)
int=10.72(3.16)
int+fu=11.15(2.92) |
1) All participants
received minimal
skills educational
intervention,
including food
measurement,
setting weight and
calorie goals, self-monitoring
blood
glucose, and foot
care.
2) Intervention—11 wk group
intervention of 2 hr
session consisting
of lecture and
slide presentation
on general
diabetes principals
and skills and
nutrition principals.
Goals for
changing eating
behavior,
increasing
physical activity,
and blood glucose
control were set.
Societal
pressures, internal
resistance to
change and lack
of self-reinforcement.
3) Intervention +
Followup
counseling—participants received
intervention plus 2
followup sessions. |
11 weeks, 12
and 18 week
followup |
Completer Results:
1) Metabolic control:
a) HbA1 % means (SD): con: 10.91 (2.6) base 10.54 (3.11) 3 mo 10.5 (3.21) 6 mo int: 10.72 (3.16) base 8.58 (2.55) 3 mo 9.17 (3.3) 6 mo int+fu: 11.15 (2.9) base 8.82 (2.8) 3 mo 8.26 (2.7) 6 mo
*RM-ANOVA indicated a significant
decrease in HbA1 for int (p<0.05) and
int+fu (p<0.01) at 3 mo on HbA1c over
time. Between groups not reported.
b) Fasting Blood Glucose (mM)
means (SD): con: 11.34 (3.29) base 10.31 (4.05) 3 mo 12.18 (5.46) 6 mo int: 11.59 (3.67) base 8.83 (2.68) 3 mo 9.45 (3.61) 6 mo int+fu: 12.21 (3.85) base 10.08 (4.66) 3 mo 9.03 (3.0) 6 mo
*RM-ANOVA indicated a significant
decrease in fasting blood glucose for
int and int+fu at 3 and 6 mo on HbA1c
over time (p<.05 for all). Between groups not reported.
2) Measures of risk:
a) Weight (lbs) means (SD): con: 215.25 (25.47) base 209.46 (25.14) 3 mo 205.14 (25.59) 6 mo int: 211.84 (27.78) base 199.96 (30.13) 3 mo 200.72 (30.44) 6 mo int+fu: 200.65 (30.7) base 192.42 (32.09) 3 mo 191.8 (31.73) 6 mo
*RM-ANOVA indicated a significant
decrease in weight for all groups at 3
mo (p<0.05 for all)
b) Cholesterol means (SD): con: 5.75 (1.19) base 5.83 (1.23) 3 mo 5.77 (1.61) 6 mo int: 6.19 (0.9) base 5.58 (0.72) 3 mo 5.71 (1.14) 6 mo int+fu: 6.08 (1.82) base 5.48 (1.63) 3 mo 5.57 (0.84) 6 mo
*RM-ANOVA indicated a significant
decrease in weight for all groups at 3
mo (p<0.05 for all)
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? 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? No
Provider training described?
No
Patients assessed for DSM
dx? No
Biases, etc:
Large number of participants
did not complete study |
#20
Didjurgeit,
Kruse,
Schmitz, et
al, 2002 |
Include: Type I
diabetes, presence of
self-reported
persistent
psychological
problem, presence of
at least one
microvascular diabetic
complications.
Exclude: not given |
Randomized wait-list
controlled trial for
patients indicating
psychological
problems—single-center
design |
N=46
n con=21
n tx=23
*2 patients died
during study-con:
1, tx: 1
Age means (SD):
con=41(10)
tx=36 (9)
61% Female
Race % not given
Baseline HbA1c
means (SD):
Completers:
tx: 9.1(2.0)
con: 8.7 (1.7) |
Psycho-therapeutic
intervention:
1) Definition of the
patient-therapist
relationship.
2) Detailed
description of a
problematic situation
of the patient.
3) Analysis of
components of the
problem.
4) Definition of the
problem.
5) Handling the
problem.
6) Conclusion of
therapy.
Plus: Diverse
psychotherapeutic
interventions to foster
awareness, modify
thoughts, modify
behavior,
emotionality,
awareness of body's
ability to rely and
support.
*all patients treated
by one therapist |
Weekly
sessions—14
session
maximum, 55-min sessions |
Completer Results:
1) Metabolic control:
-HbA1c mean (SD): total con: 8.7 (1.7) base 8.8 (1.9) f/u tx: 9.1 (2) base 8.5 (1.6) f/u
*ANOVA indicated a significant effect
of group on f/u HbA1c (p=0.016)
2) Measures of risk:
Not given
3) Events:
a) Health care utilization:
Not given
b) Morbidity/mortality:
Deaths=2; con: 1, tx: 1
4) Psychological Measures:
a) Top 3 patient-indicated problems
& severity (10- point scale)
means (SD): con: #1: 8.3 (1.72) base 6.8 (3) f/u #2: 7.61(1.79) base 5.83(2.75) f/u #3: 7.36(2.65) base 6.79(2.42) f/u tx: #1: 7.78(1.98) base 4.3 (2.87) f/u #2: 7.67(2.31) base 3.86(2.41) f/u #3: 7.71(2.33) 4.71(2.43) f/u
*ANOVA indicated a significant effect
of group on problem severity
b) Severity of psychological
distress symptoms related to
disease (Symptoms
Checklist 90 Revised-SCL-90Rc) means (SD):
con: 0.99(0.47) base 0.75(0.49) f/u tx: 1.1(0.71) base .93 (0.81) f/u
*ANOVA indicated no significant
group by time interaction for SCL-90
(p=.49)
c) Depression Score
(ZERSSENc) means (SD):
con: 13.8(8.9) base 11.7(9.8) f/u tx: 16.3(9.6) base 11.8(10.9) f/u
*ANOVA indicated no significant
group by time interaction for
ZERSSEN (p=.39).
d) Quality of Life (IRESc)
means (SD):
con: 4.7(2) base 4.3(1.6) f/u tx: 4(2.2) base 4.4(1.7) f/u
*ANOVA indicated no significant
group by time interaction for IRES
(p=.21) |
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
External Validity:
Pop. Described? Yes
Intervention described well
enough to reproduce? Yes
Intervention codified in
manual? Not sure
Provider training described?
No
Biases, etc:
4 participants in intervention
group did not complete
therapeutic sessions, yet still
completed f/u; Investigators
note that therapy not easily
replicated since not strictly
structured; No objective
measures of self-care used;
Investigators note that no
distinction made between how
closely tied "problems" were to
disease. |
#5140
Dyson,
Hammersley,
Morris,
Holman &
Turner, 1997 |
Include: Patients with
increased fasting
glucose (5.5 to 7.7
mmol/L on 2
occasions.
Exclude: diabetes
diagnosis |
RCT with 2 x 2
factorial design.
Four conditions:
1) Sulfonylurea +
reinforced healthy-living
advice (S+RA).
2) Sulfonylurea +
basic healthy-living
advice (S+BA).
3) Control(placebo/no
tablets) + reinforced
healthy-living advice
(con+RA).
4) Control(placebo/no
tablets) + basic
healthy-living advice
(con+BA).
*groups 1 and 3
considered treatment
(tx) and 2 and 4
considered control
(con) |
N=227
n S+RA=56
n S+BA=56
n con+RA=55
n con+BA=60
*26 drop-outs by 1-yr. f/u. (18 in RA, 8
in BA)
Age mean (SD):
50(9)
59% Female
Race % not given
Baseline HbA1c %
mean:
Completers: 5.7 |
1) Sulfonylurea—an antihyperglycemic—helps body better
respond to insulin
and reduces the
amount of sugar
produced by liver.
2) Basic healthy-living
advice—
given written
dietary information
and seen by a
physician who
advised weight
loss and increased
physical activity.
Patients seen
every 3 months for
assessment of
glycemia, but
basic advice was
only given once at
the initial visit.
3) Reinforced
healthy-living
advice—patients
seen by dietitian
and advised to
change their diet,
limit fat intake and
increase
consumption of
unrefined carbs
and dietary fiber.
Individual energy
requirements were calculated and
caloric
consumption. Saw
a fitness Instructor
every 3 months and
were encouraged to
increase physical
activity gradually.
Subjects filled out
food and exercise
diaries.
4) Placebo—half of
the control group
received a placebo
tablet, the other half
received no tablets. |
3 months, 1 yr
followup |
Completer Results:
1) Metabolic control - HbA1c %
RA: 5.7 base 5.6 1 year
BA: 5.7 base 5.6 1 year
*Reported no significant effect of group
on HbA1c. Statistical test not given. No
change in findings when medicated Ss
eliminated from analysis.
2) Measures of risk:
a) Weight (kg)
RA: 81.3 base 80.8 1 year
BA: 82.0 base 81.8 1 year
*Reported no significant effect of group
on weight loss. Statistical test not
given. No change in findings when
medicated Ss eliminated from analysis.
b) Systolic blood pressure-SBP
RA: 122 base 120 1 year
BA: 121 base 121 1 year
*Reported no significant effect of group
on SBP. Statistical test not given.
c) Diastolic blood pressure-DBP
RA: 78 base 77 1 year
BA: 76 base 76 1 year
*Reported no significant effect of group
on DBP. Statistical test not given.
d) HDL Cholesterol
RA: 1.1 base 1.1 1 year
BA: 1.1 base 1.1 1 year
*Reported no significant effect of group
on HDL-C. Statistical test not given.
e) LDL-Cholesterol
RA: 3.2 base 3.1 1 year
BA: 3.2 base 3.01 year
*Reported no significant effect of group
on LDL-C. 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? Yes
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:
Statistical analyses not clearly
explained; differential
attrition—more in treatment
group (RA) |
#510
Fosbury,
Bosley, Ryle,
Sonksen,
Judd, 1997 |
Include: type I
diabetes, 18-55 years
old, poor diabetes
control, HbA1c >9%.
Exclude: pregnant, in
other clinical trials, or
those living a
considerable distance
from the hospital. |
RCT with 2 treatment
conditions:
1) CAT treatment—
cognitive analytic
therapy (cat).
2) DSNE Control—
diabetes specialist
nurse education
(dsne) |
N=32
n.cat=15
n.dsne=17
*6 drop-outs (5 from
CAT, 1 from dsne)
Age means (SD):
cat=30.5(10.6)
dsne=32(9.2)
% Female:
cat=70
dsne=69
Race %:
88- Caucasian
8- African Amer.
4- Asian
Baseline HbA1 %
means (SD):
Completers:
cat=12.12(1.37)
dsne=11.76(1.88) |
1) CAT—a time
limited (16-20
sessions) focused
psychotherapy,
using
psychosomatic
and CBT methods,
where self-care
and relationships
with others are
understood as
sequences of
mental and
behavioral
processes. CAT
therapist makes
links between the
patients' past and
present
experiences and
their use of
procedures that
are ineffective and
harmful.
2) DSNE—involved teaching,
counseling, and
advice about
diabetes
management in
relation to the
personal needs
and lifestyle of the
patient. |
16 (50 min)
sessions,
approx. once a
week, 3 and 6
month followup |
Completer Results:
1) Metabolic control - HbA1 % means (SD): cat: 12.1 (1.4) base 11.0 (2.0) post 10.6 (1.3) 3 mo 10.1 (1.5) 9 mo dsne: 11.8 (1.9) base 10.6 (2.0) post 10.5 (2.2) 3 mo 10.9 (1.5) 9 mo
*t-tests indicated no significant
differences between groups. Both
groups showed significant within group
improvements at 3- and 6-months
2) Measures of risk:
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? Yes
Concealment of allocation?
Yes
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?
No
Patients assessed for DSM
dx? No
Biases, etc:
No measures of risk assessed; disproportionate attrition in
the intervention and control
group.
|
#210
Gaede, Beck,
Vedel &
Pederson,
2001 |
Include: Type 2
diabetes mellitus, age
45-65
Exclude: not stated |
RCT-single center
with 2 groups:
1) Standard
intervention (con).
2) Intensive
multifactorial
intervention (tx). |
N=160
n con=76
n tx=73
*5 drop-outs- tx: 3,
con: 2) and 6 died
Age mean (SD):
55.1 (7.2)
25% Female
Race % not given
Baseline HbA1c %
means (SD):
Intended to treat:
con: 8.8 (1.7)
tx: 8.4 (1.5) |
Both groups
received
information on diet,
exercise, and
smoking cessation.
Tx group was
taught to se
individual goals for
diet, smoking and
exercise, received
spouse-assisted
training to help
retain their goals,
engaged in self-monitoring,
and
were both
encouraged to
exercise more and
was offered
smoking cessation
programs |
6 months. |
Completer Results:
1) Metabolic control: -HbA1c % means (SD): con: 8.8 (1.7) base 9.0 (1.8) post tx: 8.4 (1.5) base 7.6 (1.0) post*
*Reported a significant decrease in
HbA1c for tx group (p<0.01), and a
significant difference between
groups at post (p<0.000001).
Statistical tests not given.
2) Measures of risk:
a) Weight (kg) means (SD): con: 89.9 (17.3) base 90.4 (16.4) post tx: 91.4 (13.6) base 95.1 (13.2) post*
*Reported a significant increase in
weight for tx group (p<0.001), and a
significant difference between groups
at post (p=0.001). Statistical test not
given.
b) Current Smokers: con: 26 base 21 post tx: 28 base 22 post
*Reported a significant decrease in
smokers for both con and tx groups
(p<0.05), yet no significant difference
between groups. Statistical test not
given.
c) Fasting Total Cholesterol means
(SD): con: 5.8 (1.3) base 5.5 (1.2) post tx: 5.4 (1) base 4.8 (0.7) post
Reported a significant decrease in
total cholesterol for tx group
(p<0.001), and a significant
difference between groups
(p=0.00003). Statistical test not
given.
d) Fasting HDL Cholesterol means
(SD): con: 1.01 (0.3) base 1.04 (0.3) post tx: 1.03 (0.2) base 1.05 (0.3) post
*Reported no significant differences
between groups at post. Statistical
tests not given.
3) Events:
a) Health care utilization:
Not given b) Morbidity/mortality:
6 patients died during f/u
|
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? No
Intervention codified in
manual? No
Provider training described?
No
Patients assessed for DSM
dx? No
Biases, etc:
Behavioral intervention not
explained clearly; statistical
analyses not stated.
|