The effectiveness of group-based self-management education for the management of type 2 diabetes mellitus: a systematic review with meta-analyses and meta-regression

Patient education for the management of type 2 diabetes mellitus (T2DM) can be delivered in various forms; with the ultimate goal of promoting and supporting positive self-management behaviours. This study aimed to determine whether group-based interventions are more effective than individual or usual care for improving clinical, lifestyle and psychosocial outcomes in persons with T2DM. Studies were obtained from six electronic databases. Group-based education programs for adults with T2DM that measured glycosylated haemoglobin (HbA1c) and followed participants for at least six months were included. The primary outcome was HbA1c, and secondary outcomes included fasting blood glucose (FBG), weight, body mass index, waist circumference, blood pressure, blood lipid profiles, diabetes knowledge and self-efficacy. Fifty-three publications describing 47 studies were included (n = 8533 participants). Greater reductions in HbA1c occurred in group-based education compared with controls at six to ten months (mean difference (MD) = 0.3%; 95% confidence interval (CI): −0.48, −0.15; P = 0.0002), 12–14 months (MD = 0.3%; 95% CI: −0.49, −0.17; P < 0.0001), 18 months (MD = 0.7%; 95% CI: −1.26, −0.18; P = 0.009), and 36–48 months (MD = 0.9%; 95% CI: −1.52, −0.34; P = 0.002), but not at 24 months. Outcomes also favoured group-based education for FBG, body weight, waist circumference, triglyceride levels, and diabetes knowledge, but not at all time points. Group-based education interventions are more effective than usual care, wait-list control and individual education at improving clinical, lifestyle and psychosocial outcomes in patients with T2DM.