Diabetes self-management programmes in older adults: a systematic review and meta-analysis

Aim The evidence for self‐management programmes in older adults varies in methodological approaches, and disease criteria. Using predetermined methodological criteria, we evaluated the effect of diabetes‐specific self‐management programme interventions in older adults. Methods The EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials databases were searched from January 1980 to November 2013, as were reference lists from systematic reviews, meta‐analyses and clinical practice guidelines. A total of 13 trials met the selection criteria, which included 4517 older adult participants; 2361 participants randomized to a diabetes self‐management programme and 2156 to usual care. Results The pooled effect on HbA1c was a reduction of –2 mmol/mol (–0.2%; 95% CI –0.3 to –0.1); tailored interventions [–3 mmol/mol (–0.2%; 95% CI –0.4 to –0.1)] or programmes with a psychological emphasis [–3 mmol/mol (–0.2; 95% CI –0.4 to –0.1)] were most effective. A pooled treatment effect on total cholesterol was a 5.81 mg/dl reduction (95% CI –10.33 to –1.29) and non‐significant reductions in systolic and diastolic blood pressure. Conclusions Diabetes self‐management programmes for older adults demonstrate a small reduction in HbA1c, lipids and blood pressure. These findings may be of greater clinical relevance when offered in conjunction with other therapies.