EFFECTIVENESS OF LAY-LED GROUP SELF-MANAGEMENT INTERVENTIONS ON HBA1C, SELF-EFFICACY AND OTHER HEALTH RELEVANT OUTCOMES ON ADULTS WITH TYPE 2 DIABETES MELLITUS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Diabetes is dilapidating health condition that is rapidly increasing in prevalence globally. Diabetes self-management education and support (DSME/S) is known as an important aspect of diabetes care. However, the effects of lay-led group self-management interventions on HbA1c levels, self-efficacy and other health relevant outcomes among T2DM adults is still inconclusive. Objectives: The objective of this systematic review is to evaluate the effectiveness of lay-led group self-management interventions on HbA1c, selfefficacy and other health relevant outcomes in adults with T2DM through reviewing current evidence. Method: Literature search was done through the following 7 databases to search for published studies: PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, SCOPUS and Web of Science. Screening and assessment for risk of bias were done by two independent reviewers. Meta-analysis was conducted for Hba1c, self-efficacy and other health related outcomes which were analysed using RevMan 5.3 software. Quality appraisal of evidence was done using GRADE. Results: 16 studies were included in this review. Meta-analysis conducted on the outcome of HbA1c levels showed a small reduction of 0.16 (95% CI [-0.28, - 0.04], p=0.008). Meta- analyses conducted on self- efficacy showed a small improvement of 0.27 (95% CI [0.19,0.36], p<0.00001). Lay-led group self-management interventions also reported a small effect size (d=0.15, 95% CI [- 0.26, -0.05, p=0.004] favouring the intervention in the meta-analysis of rate of emergency visits. Conclusions: Limitations in this review included a high risk of bias among the studies in performance, detection and attrition bias. Publication bias was also suspected to be present and reasons for heterogeneity could not be explained through subgroup analyses. Recommendations for future research to reduce potential biases and meta-regression could be considered if there are enough studies and significant heterogeneity observed. Results of this review could point towards an potentially feasible and effective treatment for those with uncontrolled diabetes allowing them to manage and sustain self-care behaviours.