Abstract
Purpose: Type 2 diabetes is a widespread metabolic disease globally (Sun et al., 2022). People living with type 2 diabetes commonly suffer from neuropathy, nephropathy, retinopathy, and cardiovascular disease, leading to increased medical burden and reduced quality of life (Fakhri et al., 2021; Williams et al., 2020). Therefore, it is crucial to develop effective strategies for managing type 2 diabetes. Prior conventional pairwise meta-analysis (Azmiardi et al., 2021; Bekele et al., 2021; Nkhoma et al., 2021; Tanaka et al., 2020) have respectively investigated the advantages of Diabetes Self-Management Education (DSME), Diabetes Self-Management Support (DSMS), and Diabetes Self-Management Education and Support (DSMES) for improving glycated haemoglobin (HbA1c) in type 2 diabetes. However, current evidence lacks a comparative analysis of all three interventions simultaneously, making it challenging for medical staff to determine the most effective approach for managing diabetes outcomes. Therefore, we aimed to compare the effects of various diabetes education programs, namely DSME, DSMS, and DSMES, on HbA1c of patients living with type 2 diabetes by performing network meta-analysis (NMA).
Methods: The PubMed, Embase, CINAHL, and ProQuest Dissertations and Theses were used to locate eligible articles from the databases' founding until February 1, 2023. Randomized controlled trials evaluating the HbA1c level were included. Data on study and participant characteristics, treatment details, and outcomes of interest were extracted from each included study by two authors and recorded in a predesigned extraction sheet. Disagreements were resolved through conversation. Data were pooled with a random-effects model under a frequentist framework.
Results: A total of 105 studies involving 16340 participants with a mean age of 55.6 years were included. All included RCTs adopted a two-arm parallel design. Results from NMAs including 4 programs revealed that, compared with usual care (UC), DSMES was the most effective education program for significantly reducing HbA1c level (mean difference = -0.63, 95% confidence interval [CI] = -0.76 to -0.51) in patients with type 2 diabetes.
Conclusion: This network meta-analysis demonstrates that Diabetes Self-Management Education and Support (DSMES) is the most effective diabetes education program compared to usual care in terms of improving HbA1c levels in patients living with type 2 diabetes. Diabetes educators should incorporate the DSMES concept when designing and implementing educational programs in order to optimize glycemic control in type 2 diabetes.
Notes
References:
Azmiardi, A., Murti, B., Febrinasari, R. P., & Tamtomo, D. G. (2021). The effect of peer support in diabetes self-management education on glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis. Epidemiology and health, 43.
Bekele, B. B., Negash, S., Bogale, B., Tesfaye, M., Getachew, D., Weldekidan, F., & Balcha, B. (2021). Effect of diabetes self-management education (DSME) on glycated hemoglobin (HbA1c) level among patients with T2DM: Systematic review and meta-analysis of randomized controlled trials. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 15(1), 177-185.
Fakhri, M., Abdan, M., Ramezanpour, M., Dehkordi, A. H., & Sarikhani, D. (2021). Systematic review and meta-analysis on quality of life in diabetic patients in Iran. International journal of preventive medicine, 12.
Nkhoma, D. E., Soko, C. J., Bowrin, P., Manga, Y. B., Greenfield, D., Househ, M., Li, Y.-C., & Iqbal, U. (2021). Digital interventions self-management education for type 1 and 2 diabetes: A systematic review and meta-analysis. Computer methods and programs in biomedicine, 210, 106370.
Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B. B., Stein, C., Basit, A., Chan, J. C., & Mbanya, J. C. (2022). IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes research and clinical practice, 183, 109119.
Tanaka, R., Shibayama, T., Sugimoto, K., & Hidaka, K. (2020). Diabetes self-management education and support for adults with newly diagnosed type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. Diabetes research and clinical practice, 169, 108480.
Williams, R., Karuranga, S., Malanda, B., Saeedi, P., Basit, A., Besançon, S., Bommer, C., Esteghamati, A., Ogurtsova, K., & Zhang, P. (2020). Global and regional estimates and projections of diabetes-related health expenditure: Results from the International Diabetes Federation Diabetes Atlas. Diabetes research and clinical practice, 162, 108072.
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Meta-Analysis/Synthesis
Research Approach
Quantitative Research
Keywords:
Type 2 Diabetes, People with Diabetes, Health Education, Glycosylated Hemoglobin, Glycemic Control, Self-Management (Psychology)
Recommended Citation
Romadlon, Debby Syahru and Chiu, Hsiao-Yean, "A Network Meta-Analysis of Effects of Diabetes Education Programs on HbA1c in Type 2 Diabetes" (2026). International Nursing Research Congress (INRC). 7.
https://www.sigmarepository.org/inrc/2024/presentations_2024/7
Conference Name
35th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Singapore
Conference Year
2024
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-11-03
A Network Meta-Analysis of Effects of Diabetes Education Programs on HbA1c in Type 2 Diabetes
Singapore
Purpose: Type 2 diabetes is a widespread metabolic disease globally (Sun et al., 2022). People living with type 2 diabetes commonly suffer from neuropathy, nephropathy, retinopathy, and cardiovascular disease, leading to increased medical burden and reduced quality of life (Fakhri et al., 2021; Williams et al., 2020). Therefore, it is crucial to develop effective strategies for managing type 2 diabetes. Prior conventional pairwise meta-analysis (Azmiardi et al., 2021; Bekele et al., 2021; Nkhoma et al., 2021; Tanaka et al., 2020) have respectively investigated the advantages of Diabetes Self-Management Education (DSME), Diabetes Self-Management Support (DSMS), and Diabetes Self-Management Education and Support (DSMES) for improving glycated haemoglobin (HbA1c) in type 2 diabetes. However, current evidence lacks a comparative analysis of all three interventions simultaneously, making it challenging for medical staff to determine the most effective approach for managing diabetes outcomes. Therefore, we aimed to compare the effects of various diabetes education programs, namely DSME, DSMS, and DSMES, on HbA1c of patients living with type 2 diabetes by performing network meta-analysis (NMA).
Methods: The PubMed, Embase, CINAHL, and ProQuest Dissertations and Theses were used to locate eligible articles from the databases' founding until February 1, 2023. Randomized controlled trials evaluating the HbA1c level were included. Data on study and participant characteristics, treatment details, and outcomes of interest were extracted from each included study by two authors and recorded in a predesigned extraction sheet. Disagreements were resolved through conversation. Data were pooled with a random-effects model under a frequentist framework.
Results: A total of 105 studies involving 16340 participants with a mean age of 55.6 years were included. All included RCTs adopted a two-arm parallel design. Results from NMAs including 4 programs revealed that, compared with usual care (UC), DSMES was the most effective education program for significantly reducing HbA1c level (mean difference = -0.63, 95% confidence interval [CI] = -0.76 to -0.51) in patients with type 2 diabetes.
Conclusion: This network meta-analysis demonstrates that Diabetes Self-Management Education and Support (DSMES) is the most effective diabetes education program compared to usual care in terms of improving HbA1c levels in patients living with type 2 diabetes. Diabetes educators should incorporate the DSMES concept when designing and implementing educational programs in order to optimize glycemic control in type 2 diabetes.
Description
This network meta-analysis shows Diabetes Self-Management Education and Support (DSMES) to be the top-performing program for improving HbA1c level. Time to prioritize DSMES in diabetes education design!