Individualised behavioural goal setting : its influence on glycaemic control amongst adults with diabetes

Abstract

Topic Overview: Diabetes mellitus is highly prevalent, and is a cause of disability, diminished quality of life, and premature mortality. Avoidance of complications requires individuals to self-manage their condition to achieve glycaemic control. Evidence-based programmes which support individuals to gain the knowledge and skills necessary to self-manage are therefore required. Research Question: Does setting individualised lifestyle change goals within a selfmanagement programme improve the glycaemic control of adults with type II diabetes mellitus (T2DM)? PICO Elements: The population studied comprised of adults with T2DM. The intervention under review was setting individualised lifestyle change goals within a selfmanagement programme. The comparison intervention was either no intervention, usual care, or education only programmes. The expected outcome was improved glycaemic control. Methods: Various search terms were identified and combined with search tools and limiters to create unique search strategies for each database/platform. PubMed and ScienceDirect were searched, amongst others. Unpublished research was also searched for. PRISMA was used as a framework for screening articles. Detailed eligibility criteria were applied to guide the selection of key studies. Randomised controlled trials (RCTs), systematic reviews, and meta-analyses were eligible for inclusion, and reports had to be written in English and published after 2007. CASP tools, the Cochrane Collaboration’s tool for assessing risk of bias, and AMSTAR guided the appraisal process. Results: The key studies consisted of four RCTs, one systematic review, and two metaanalyses. Results from the studies were inconsistent, despite strongly significant treatment effects identified in the meta-analyses. Various methodological differences and limitations identified could in part explain inconsistencies. The research question was not answered definitively, however this review identified tentative evidence supporting the intervention. Implications and Recommendations: Recommendations for further research include conducting trials into existing interventions, using larger sample sizes and extended follow-up periods. Implementation of self-management programmes locally requires staff awareness and training. Moreover greater allocation of financial resources is necessary