• Jennifer Pillay, Marni J Armstrong, Sonia Butalia, Lois E Donovan, Ronald J Sigal, Pritam Chordiya, Sanjaya Dhakal, Ben Vandermeer, Lisa Hartling, Megan Nuspl, Robin Featherstone, and Donna M Dryden.
• Ann. Intern. Med. 2015 Dec 1; 163 (11): 836-47.

BackgroundWhether behavioral approaches for self-management programs benefit individuals with type 1 diabetes mellitus is unclear.PurposeTo determine the effects of behavioral programs for patients with type 1 diabetes on behavioral, clinical, and health outcomes and to investigate factors that might moderate effect.Data Sources6 electronic databases (1993 to June 2015), trial registries and conference proceedings (2011 to 2014), and reference lists.Study Selection36 prospective, controlled studies involving participants of any age group that compared behavioral programs with usual care, active controls, or other programs.Data ExtractionOne reviewer extracted and another verified data. Two reviewers assessed quality and strength of evidence (SOE).Data SynthesisModerate SOE showed reduction in glycated hemoglobin (HbA1c) at 6 months after the intervention compared with usual care (mean difference, -0.29 [95% CI, -0.45 to -0.13] percentage points) and compared with active controls (-0.44 [CI, -0.69 to -0.19] percentage points). At the end of the intervention and 12-month follow-up or longer, there were no statistically significant differences in HbA1c (low SOE) for comparisons with usual care or active control. Compared with usual care, generic quality of life at program completion did not differ (moderate SOE). Other outcomes had low or insufficient SOE. Adults appeared to benefit more for glycemic control at program completion (-0.28 [CI, -0.57 to 0.01] percentage points) than did youth (-0.12 [CI, -0.43 to 0.19] percentage points). Program intensity appeared not to influence effectiveness; some individual delivery appears beneficial.LimitationsAll studies had medium or high risk of bias. There was scarce evidence for many outcomes.ConclusionBehavioral programs for type 1 diabetes offer some benefit for glycemic control, at least at short-term follow-up, but improvement for other outcomes has not been shown. (PROSPERO registration number: CRD42014010515).Primary Funding SourceAgency for Healthcare Research and Quality. (PROSPERD registration number: CRD42014010515).

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