Contact person
Dr Amit Gupta
Amrapali Hospital
Greater NOIDA
123456 Greater NOIDA
India
Presenting author
Dr Amit Gupta
Amrapali Hospital
Greater NOIDA
123456 Greater NOIDA
India

Abstract - Diabetes in Society and Culture
Topic
Diabetes education
Abstract title
Systematic Review of 19 Published RCCTs Evaluating Diabetes Self-Management Education as a Novel Approach to Manage T2DM
Co-authors
A. Gupta1, S. Srivastava2, A. Aggarwal3, N. Wadhwa4.
1Amrapali Hospital, Medicine, Greater NOIDA, India.
2Sharda University, School of Medical Sciences and Research, Greater NOIDA, India.
3University College of Medical Sciences, Delhi, India.
4AUW Global, Delhi, India.

Abstract body
Background
India is home to the second largest population of people with diabetes with approximately 70 million with diabetes with another 30 million in prediabetes group. Diabetes self-management education (DSME) is a critical element of care for all people with diabetes and those at risk for developing the disease. It is necessary to prevent or delay the complications of diabetes and has elements related to lifestyle changes that are also essential for individuals with prediabetes as part of efforts to prevent the disease. Many people with diabetes have or are at risk for developing comorbidities, including both diabetes-related complications and conditions that may interfere with self-care 

Aim
To explore the evidence for the contemporary role of DSME to modulate the outcomes in patients with T2DM. We also intend to evaluate if DSME could be a novel armamentarium in the management of difficult to treat diabetes and understand the quality of the published evidences through the highest level of evidences ie: Randomised Controlled Clinical Trials (RCCTs)

Method
We searched Cochrane Library, pubmed- MEDLINE, IndMED online databases to conduct a systematic review of the published Randomised Controlled Clinical Trials (RCCTs) evaluating the contemporary role of DSME to modulate the outcomes in patients with T2DM. The RCCTs with non DSME, non-peer led, only physician intervention, only diabetes educator based approach were excluded by using the Boolean operators. Appropriate filters with keywords T2DM, DSME, self-education, management of diabetes, peer group education was used. Graph pad prism 7.0 version software and t-test was utilised for statistical analysis. 

Results
The results yielded 19 clinical trials of which 13 met the inclusion criteria, which are published in last 5 years (2011 to 2015). Only the studies with in person DSME approach were included for the analysis. The parameters were analysed for the study design, patient characteristics, geography of the study, impact factor of the journals, intervention, duration, and outcomes by using the appropriate statistical methods. Cumulatively, 1909 patients (mean 146.8 patients, SD ± 123.9, SEM ± 34.37, minimum 32 patients, maximum 516 patients, 95% CI 71.95 to 221.7, p=0.0011) have been evaluated across 13 RCCTs. The cumulative duration of the trials was 400 weeks (mean 30.77 weeks, SD ± 21.81, SEM ± 6.049, minimum 4 patients, maximum 72 weeks, 95% CI 17.59 to 43.95, p=0.0003). USA is the predominant country which contributes to the evidence (n=11) followed by one each from Norway and Hong Kong. The HbA1c reduction reported was mean -0.8% (SD ± 0.74, SEM ± 0.20, minimum -2.1%, maximum 0.4%, 95% CI -1.26 to -0.35, p=0.0021). Based on the impact factor of the journals (mean 2.85, minimum 1.014, maximum 8.42, SD ± 1.98, SEM ± 0.54, 95% CI 1.65 to 4.04; p=0.0002), we formulated an indexed weightage score (mean 100, minimum 35.58, maximum 295.5, SD ± 69.54, SEM ± 19.29, 95% CI 57.98 to 142). The highest no. of RCCTs were published in the Diabetes Educator journal (current impact factor of 1.792). The important study designs included the secondary analyses of data from the landmark Diabetes Self-Care Study, secondary outcomes evaluating the cardiovascular disease risk factors, diabetes distress, diabetes social support, general physical and mental health. The outcomes from these RCCTs demonstrate that participants can reduce HbA1c. Even in emergency care setting DSME has been found to be a useful tool.

Discussion
The evaluation of the contemporary published evidences reveal that DSME is a guideline directed tool with immense potential to modulate the outcomes in T2DM. The locally developed, customised ongoing diabetes self-management education programs would be important to prevent an increase in HbA1c and can influence HbA1c in patients with higher glycemic levels, with increased adherence to the ongoing medication.

Systematic review of 19 published RCCTs evaluating diabetes self-management education as a novel approach to manage T2DM