Effect of self-help interventions on psychological, glycemic, and behavioral outcomes in patients with diabetes: A meta-analysis of randomized controlled trials

Abstract

Background: Self-help interventions are beneficial for patients with diabetes; however, related studies have reported conflicting results. To date, no review has examined the effect of self-help interventions on diabetes outcomes.

Objectives: To systematically evaluate the effects of self-help interventions on psychological, glycemic, and behavioral outcomes in patients with diabetes.

Design: A systematic review and meta-analysis of randomized controlled trials.

Methods: Five databases-PubMed, CINAHL, Embase, PsycINFO, and ClinicalTrials.gov-were searched from 1996, 1937, 1947, 1887, and 2000, respectively, to 2 June 2023. Studies that employed a randomized controlled trial design, enrolled adults with diabetes, implemented a self-help intervention as the main or an additional intervention, and reported the outcomes of interest were included. Studies providing self-help interventions to patients with gestational diabetes or pregnant women were excluded. The primary outcomes were diabetes distress, depression, and anxiety, and the secondary outcomes were glycemic and behavioral outcomes (self-management behavior, self-efficacy, and quality of life). Hedges' g and the associated 95 % confidence interval (CI) were calculated using a random-effects model to obtain the pooled estimates of short-, mid-, and long-term effects of self-help interventions. Heterogeneity was explored using I² and Q statistics, and moderator analysis was performed to identify the sources of heterogeneity.

Results: Of 17 eligible studies, 16 provided data for meta-analysis. We included 3083 patients with diabetes; the majority were women (61.95 %), and their average age was 55.13 years. Self-help interventions exerted significant short-term effects on diabetes distress (g = -0.363; 95 % CI = -0.554, -0.173), depression (g = -0.465; 95 % CI = -0.773, -0.156), anxiety (g = -0.295; 95 % CI = -0.523, -0.068), glycosylated hemoglobin level (g = -0.497; 95 % CI = -0.791, -0.167), self-efficacy (g = 0.629; 95 % CI = 0.060, 1.197), and quality of life (g = 0.413; 95 % CI = 0.104, 0.721; g = 0.182; 95 % CI = 0.031, 0.333; and g = 0.469; 95 % CI = 0.156, 0.783 for overall, physical, and mental domains, respectively). We also noted significant mid-term effects of self-help interventions on diabetes distress (g = -0.195; 95 % CI = -0.374, -0.016), self-management behavior (g = 0.305; 95 % CI = 0.155, 0.454), and overall quality of life (g = 0.562; 95 % CI = 0.315, 0.810). The certainty of evidence ranged from high to very low certainty for the measured outcomes.

Conclusions: Self-help interventions may have some positive effects on diabetes distress, anxiety, self-management behavior, and quality of life.

Registration: This review was registered in PROSPERO (CRD42022329905).

Tweetable abstract: This meta-analysis demonstrated that self-help interventions might improve psychological and behavioral outcomes in patients with diabetes.

Keywords: Diabetes mellitus; Distress; Meta-analysis; Psychological problems; Self-help interventions; Self-management behavior.