U.S. Department of Health and Human Services

National Diabetes Education Program

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  • Title: An Assessment of Patient Education and Self-Management in Diabetes Disease Management—Two Case Studies

    Author: Fitzner K, Greenwood D, Payne H, Thomson J, Vukovljak L, McCulloch A, Specker JE

    This literature review indicated that techniques and interventions based on cognitive theories and behavioral change can be effective when coupled with diabetes disease managment (DM). Better diabetes self-management through diabetes education encourages participation in DM programs and adherence to recommended care in programs offered by DM organizations or those that are provider based. Improved health outcomes and reduced cost can be achieved by blending diabetes education and DM. Two case studies are provided to illustrate these principles.

    Year Published: 2008

    Fitzner K, Greenwood D, Payne H, Thomson J, Vukovljak L, McCulloch A, Specker JE. An assessment of patient education and self-management in diabetes disease management—two case studies. Popul Health Manag. 2008 Dec;11(6):329-40.

  • Title: Assessing the Value of Diabetes Education

    Author: Duncan I, Birkmeyer C, Coughlin S, Li QE, Sherr D, Boren S

    The purpose of this study was to evaluate the impact of diabetes self-management education/training (DSME/T) on financial outcomes (cost of patient care). The analysis of large commercial and Medicare claims datasets indicates that quality can be improved, and cost reduced, by increasing referral rates to diabetes education among low-referring physicians, specifically among men and people in disadvantaged areas.

    Year Published: 2009

    Duncan I, Birkmeyer C, Coughlin S, Li QE, Sherr D, Boren S. Assessing the Value of Diabetes Education. Diabetes Educ. 2009 Sep-Oct;35(5):752-60.

  • Title: Behavioral Programs for Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis

    Author: Pillay J, Armstrong MJ, Butalia S, et al.

    This systematic review and meta-analysis examined 36 studies to determine the effects of behavioral programs for patients with type 1 diabetes on behavioral, clinical, and health outcomes and to investigate factors that might moderate effect. Researchers found behavioral programs offer some benefit for glycemic control, at least at short-term follow-up, but improvement for other outcomes has not been shown.

    Year Published: 2015

    Pillay J, Armstrong MJ, Butalia S, et al. Behavioral Programs for Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(11):836-47.

  • Title: Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis

    Author: Pillay J, Armstrong MJ, Butalia S, et al.

    This systematic review and meta-analysis examined 132 studies to identify factors moderating the effectiveness of behavioral programs for adults with type 2 diabetes. Researchers found diabetes self-management education offering 10 or fewer hours of contact with delivery personnel provided little benefit. Behavioral programs seem to benefit persons with suboptimal or poor glycemic control more than those with good control.

    Year Published: 2015

    Pillay J, Armstrong MJ, Butalia S, et al. Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis. Ann Intern Med. 2015;163(11):848-60.

  • Title: Culturally Appropriate Health Education for Type 2 Diabetes Mellitus in Ethnic Minority Groups

    Author: Hawthorne K, Robles Y, Cannings-John R, Edwards AG

    This systematic review assessed the effectiveness of culturally appropriate health education for individuals = age 16 in ethnic minority groups with type 2 diabetes mellitus. Culturally appropriate health education has short- to medium-term effects (4 -6 months) on glycemic control and on knowledge of diabetes and healthy lifestyles. More randomized clinical trials (lasting >12 months) are needed to assess clinically meaningful long term cost-effectiveness in high risk racial and ethnic groups.

    Year Published: 2008

    Hawthorne K, Robles Y, Cannings-John R, Edwards AG. Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006424.

  • Title: Diabetes Attitudes, Wishes and Needs second study (DAWN2): Cross-national benchmarking indicators for family members living with people with diabetes

    Author: Kovacs Burns K, Nicolucci A, Holt RI, Willaing I, Hermanns N, Kalra S, Wens J, Pouwer F, Skovlund SE, Peyrot M; DAWN2 Study Group.

    This article summarizes descriptive data from a survey of family members of individuals with type 2 diabetes. The survey was completed as part of the Diabetes Attitudes, Wishes, and Needs 2 (DAWN2) study and its results suggest that psychosocial problems (e.g., distress, negative emotional well-being, worry about hypoglycemia) affect many family members of people with diabetes.

    Year Published: 2013

    Kovacs Burns K, et al. Diabetes Attitudes, Wishes and Needs second study (DAWN2): Cross-national benchmarking indicators for family members living with people with diabetes. Diabet Med 2013;30:778–788.

  • Title: Diabetes Attitudes, Wishes and Needs second study (DAWN2): Cross-national comparisons on barriers and resources for optimal care – healthcare professional perspective

    Author: Holt RI, Nicolucci A, Kovacs Burns K, Escalante M, Forbes A, Hermanns N, Kalra S, Massi-Benedetti M, Mayorov A, Menéndez-Torre E, Munro N, Skovlund SE, Tarkun I, Wens J, Peyrot M; DAWN2 Study Group.

    This article describes health care professionals' perceptions of their patients in the following areas: quality of life, treatment burden, societal issues, involvement and empowerment, self-management, health care provision, and education/training. Data are from the Diabetes, Attitudes, Wishes, and Needs Study 2 (DAWN2).

    Year Published: 2013

    Holt RIG, et al. Diabetes Attitudes, Wishes and Needs second study (DAWN2): Cross-national comparisons on barriers and resources for optimal care – healthcare professional perspective. Diabet Med 2013;30:789–798.

  • Title: Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

    Author: Powers MA, Bardsley J, Cypress M, et al.

    This position paper from the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics focuses on the benefits of diabetes self-management education and support for individuals with type 2 diabetes and presents an algorithm for when to refer patients to a self-management program.

    Year Published: 2015

    Powers MA, Bardsley J, Cypress M, et al. Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Care. 2015;38(7):1372-82.

  • Title: Does Tailoring Matter? Meta-Analytic Review of Tailored Print Health Behavior Change Interventions

    Author: Noar SM, Benac CN, Harris MS

    This meta-analytic review of 57 studies focused on the effects of tailored print health behavior change interventions.

    Year Published: 2007

    Noar SM, Benac CN, Harris MS. Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychol Bull. 2007 Jul;133(4):673-93.

  • Title: How do mobile phone diabetes programs drive behavior change? Evidence from a mixed methods observational cohort study

    Author: Nundy S, Mishra A, Hogan P, Lee SM, Solomon MC, Peek ME.

    The purpose of this study was to investigate the behavioral effects of a theory-driven, mobile phone-based intervention combining automated text messaging and remote nursing, using an automated, interactive text messaging system. This study's findings support the idea that behaviorally driven mobile health interventions can address multiple behavioral pathways associated with sustained behavior change.

    Year Published: 2014

    Nundy S, Mishra A, Hogan P, Lee SM, Solomon MC, Peek ME. How do mobile phone diabetes programs drive behavior change? Evidence from a mixed methods observational cohort study. Diabetes Educ. 2014;40(6):806-19.

  • Title: Impact of Intensive Lifestyle Intervention on Depression and Health-Related Quality of Life in Type 2 Diabetes: The Look AHEAD Trial

    Author: Rubin RR, Wadden TA, Bahnson JL, et al.

    The Look AHEAD study was a randomized controlled trial of overweight/obese participants with type 2 diabetes who were assigned to Intensive Lifestyle Intervention (ILI) to achieve weight loss, or a control group who received traditional diabetes support and education (DSE). Participants were assessed for depression at baseline, annually at years 1–4, and again at year 8. Results showed those in the ILI significantly reduced the incidence of mild or greater depression symptoms compared with DSE. ILI participants also reported better physical function than DSE participants throughout the first 8 years of the study.

    Year Published: 2014

    Rubin RR, Wadden TA, Bahnson JL, et al. Impact of intensive lifestyle intervention on depression and health-related quality of life in type 2 diabetes: the Look AHEAD Trial. Diabetes Care. 2014;37(6):1544-53.

  • Title: Lifestyle and Behavior: The Diabetes Attitudes, Wishes and Needs (DAWN) Program: A New Approach to Improving Outcomes of Diabetes Care

    Author: Skovlund SE, Peyrot M, DAWN International Advisory Panel

    This article summarizes key findings of the original multi-site, multi-national DAWN Study designed to understand the patient's perspectives about living with diabetes and diabetes care, and those of diabetes care providers. It also discusses the implications of these findings and identifies strategies for translating goals into actions.

    Year Published: 2005

    Skovlund SE, Peyrot M, DAWN International Advisory Panel. Lifestyle and behavior: the diabetes attitudes, wishes and needs (DAWN) program: a new approach to improving outcomes of diabetes care. Diabetes Spectrum. 2005;18:136-142

  • Title: Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials

    Author: Franz MJ, Boucher JL, Rutten-ramos S, Vanwormer JJ.

    This systematic review and meta-analysis examined the impact of lifestyle weight-loss interventions (resulting in weight losses >5% or <5% at 12 months) on A1C in overweight or obese adults with type 2 diabetes. Weight loss of >5% appears necessary for beneficial effects on A1C, lipids, and blood pressure. Achieving weight loss of >5% requires intense interventions, including energy restriction, regular physical activity, and frequent contact with health professionals.

    Year Published: 2015

    Franz MJ, Boucher JL, Rutten-ramos S, Vanwormer JJ. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. J Acad Nutr Diet. 2015;115(9):1447-63.

  • Title: Meta-Analysis of Patient Education Interventions to Increase Physical Activity Among Chronically Ill Adults

    Author: Conn VS, Hafdahl AR, Brown SA, Brown LM

    This meta-analysis article synthesized 163 published reports on testing the effect of patient education to increase physical activity among 22,527 adults with diverse chronic illnesses from 213 samples. Preliminary moderator analyses suggest interventions that targeted on physical activity behavior, used behavioral strategies, and encouraged physical activity self-monitoring were most effective.

    Year Published: 2008

    Conn VS, Hafdahl AR, Brown SA, Brown LM. Meta-analysis of patient education interventions to increase physical activity among chronically ill adults. Patient Educ Couns. 2008 Feb;70(2):157-72. Epub 2007 Nov 26.

  • Title: Nursing Interventions for Smoking Cessation

    Author: Rice VP, Stead LF

    This review sought to determine the effectiveness of nursing-delivered smoking cessation interventions.The results indicate the potential benefits of smoking cessation advice and/or counselling given by nurses to patients, with reasonable evidence that intervention is effective. Authors note the challenge will be to incorporate smoking behaviour monitoring and smoking cessation interventions as part of standard practice.

    Year Published: 2008

    Rice VP, Stead LF. Nursing interventions for smoking cessation. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD001188.

  • Title: Patient-Centered Goal Setting as a Tool to Improve Diabetes Self-Management

    Author: Langford AT, Sawyer DR, Gioimo S, Brownson CA, O'Toole ML

    This article describes the process of collaborative goal setting as a means to improve diabetes self-management in primary care.

    Year Published: 2007

    Langford AT, Sawyer DR, Gioimo S, Brownson CA, O'Toole ML. Patient-centered goal setting as a tool to improve diabetes self-management. Diabetes Educ. 2007 Jun;33 Suppl 6:139S-144S.

  • Title: Performance of a Brief Dietary Assessment and Intervention Tool for Health Professionals

    Author: Paxton AE, Strycker La, Toobert DJ, Ammerman AS, Glasgow RE

    This article evaluates a brief 8-item dietary assessment tool called Starting the Conversation (STC), for feasibility, validity and sensitivity to change of the STC tool. Researchers found that the eight STC items and summary score performed well. The brief STC is a relatively simple, valid, and efficient tool for dietary assessment and intervention in the clinical setting. It is available in English and Spanish and is in the public domain.

    Year Published: 2011

    Paxton A, Strycker L, Toobert D, Ammerman A, Glasgow R. Starting the conversation: performance of a brief dietary assessment and intervention tool for health professionals. Am J Prev Med. 2011; 40(1): 67-71.

  • Title: Self-Determination Theory Applied to Health Contexts: A Meta-Analysis

    Author: Ng JY, Ntoumanis N, Thøgersen-ntoumani C, et al.

    This meta-analysis evaluated the relationship between the Self-Determination Theory (SDT)-based constructs of practitioner support for patient autonomy and patients’ experience of psychological need satisfaction, as well as the relationship between these SDT constructs and indices of mental and physical health.

    Year Published: 2012

    Ng J, Ntoumanis N, Thøgersen-Ntoumani C, et al. Self-determination theory applied to health contexts: a meta-analysis. Perspect Psychol Sci. 2012; 7: 325-340.

  • Title: State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change

    Author: Spahn JM, Reeves RS, Keim KS, Laquatra I, Kellogg M, Jortberg B, Clark NA

    This article is a systematic evaluation of 87 peer reviewed articles related to behavior change theories and strategies used in nutrition counseling. Results demonstrate strong evidence to support the use of cognitive behavioral therapy(CBT) in patients with type 2 diabetes. Motivational interviewing was shown to be a highly effective counseling strategy, particularly when combined with CBT. Strong evidence substantiates the effectiveness of self-monitoring and meal replacements and/or structured meal plans.

    Year Published: 2010

    Spahn JM, Reeves RS, Keim KS, Laquatra I, Kellogg M, Jortberg B, Clark NA. State of the evidence regarding behavior bhange theories and strategies in nutrition counseling to facilitate health and food behavior change. J AM Diet Assoc. 2010 Jun;110(6):879-91.

  • Title: Supporting Patient Behavior Change: Apporaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels

    Author: Greene J, Hibbard JH, Alvarez C, Overton V.

    The purpose of this study was to to identify the strategies used to support patient behavior change by clinicians whose patients had an increase in patient activation. The study's findings conclude that the 5 key strategies used by clinicians with high patient activation change are promising approaches to supporting patient behavior change that should be tested in a larger sample of clinicians to validate their effectiveness.

    Year Published: 2016

    Greene J, Hibbard JH, Alvarez C, Overton V. Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels. Ann Fam Med. 2016;14(2):148-54.

  • Title: Twenty First Century Behavioral Medicine: A Context for Empowering Clinicians and Patients with Diabetes

    Author: Marrero DG, Ard J, Delamater AM, Peragallo-Dittko V, Mayer-Davis EJ, Nwankwo R, Fisher EB.

    This article discusses important issues in behavioral medicine, including psychosocial factors and approaches focused on individuals or the broader contexts of community and culture. It includes implications and lessons for clinical practice and development of improved approaches to promoting engagement in diabetes care, effective diabetes self-management, and quality of life among those with the disease.

    Year Published: 2013

    Marrero D, Ard J, Delamater A, et al. Twenty-first century behavioral medicine: a context for empowering clinicians and patients with diabetes: a consensus report. Diabetes Care. 2013; 36:463-470.