Better evidence needed on the effectiveness of tailored interventions on self-management type 2 diabetes

A doctor and patient discuss medicines

This systematic review set out to establish whether treatment interventions that systematically tailor care according to an individual patient’s characteristics and objectives are more effective than usual care at influencing self-management behaviour.

Clinical question:

In type 2 diabetes, do tailored interventions improve self-management?

The reviewers also looked at tailored interventions on self-management of hypertension and heart disease.

The evidence:

The reviewers found ten studies and concluded:

Tailored interventions had no impact on self-management activities such as medication adherence, self-monitoring, exercise, smoking, or diet control. However, tailored interventions were modestly successful in improving specific self-management behaviours of dietary fat intake, levels of physical activity or screening.

Appraisal hints:

  • Although the reviewers included a broad range of databases, their search was carried out in 2010.  It seems likely that other important evidence has been published since.
  • This is a difficult topic area for which to conduct a sensitive and specific search, due to potential ambiguity and synonyms for “tailored interventions”.
  • The studies were found to be of low methodological quality, leading to a high risk of bias in the results.
  • The interventions are likely to be so different as to preclude meta-analysis.  There remains much work to be done on specifying exactly what is meant by “tailored” interventions.  Most clinicians would insist, quite rightly, that they already tailor education and information to their patients’ needs.  So how exactly do these interventions differ from normal practice in the context of diabetes?
  • The review was also poorly defined in terms of the populations and outcomes of interest, which vary hugely between disease areas.
  • Look for a good quality individual study that focuses on your specific clinical area.

Reference

Radhakrishnan K. The efficacy of tailored interventions for self-management outcomes of type 2 diabetes, hypertension or heart disease: a systematic review. J Adv Nurs. 2012 Mar;68(3):496-510.  doi: 10.1111/j.1365-2648.2011.05860.x.

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Badenoch

Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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