Effectiveness of Educational and Psychoeducational Self-Management Interventions in Children and Adolescents With Type 1 Diabetes: A Systematic Review and Meta-Analysis.

Abstract

Aim: Type 1 diabetes (T1D) is one of the most common chronic conditions in children and adolescents. Approximately 1.5 million young people are currently living with T1D throughout the world. Despite recent improvement in overall indices of metabolic control in children and adolescents with T1D, control remains suboptimal and additional approaches are needed. The aim of the study was to conduct a systematic review and meta-analysis of educational and psychoeducational self-management interventions, to help optimize future interventions including physical activity support. Methods: A systematic review and meta-analysis were conducted according to our registered protocol (PROSPERO CRD42022295932) and are reported in line with the PRISMA 2020 guidance. We searched five databases (MEDLINE, EMBASE, PsycINFO [via Ovid], CINAHL [via EBSCO], Cochrane Library) from 1994 up to May 2024. We included randomized controlled trials assessing the effectiveness of self-management interventions. Outcomes of interest included HbA1c and quality of life (QoL) as well as self-care behaviors, diabetes knowledge, and self-efficacy. Meta-analyses were conducted using a random effects model. Results: In total, 46 papers were included, reporting on 30 interventions. Meta-analyses showed small short-term improvements in HbA1c (MD = -2.58 mmol/L, 95% CI -4.44 to -0.71, p=0.007) and QoL (mean difference [MD] = 1.37, 95% CI 0.19-2.54, p=0.02). Prespecified subgroup analyses suggested no significant difference in effectiveness of psychoeducational and education-only interventions. Quality of included studies was low with 27 having a high risk of bias. Conclusion: There is a lack of robust evidence that current self-management interventions result in clinically meaningful improvements in HbA1c and QoL. Future research should focus on redefining approaches to supporting and encouraging self-management.