Original article| Volume 41, ISSUE 10, P1007-1030, 1988

Meta-analysis of the effects of educational and psychosocial interventions on management of diabetes mellitus

  • Deborah Padgett
    Address reprint requests to: Deborah Padgett, Ph.D., School of Social Work, New York University, 3 Washington Square North, New York, NY 10003, U.S.A.
    Division of Health Utilization and Policy Research, Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY 10032, U.S.A.
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  • Emily Mumford
    Division of Health Utilization and Policy Research, Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY 10032, U.S.A.
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  • Margaret Hynes
    Division of Health Utilization and Policy Research, Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY 10032, U.S.A.
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  • Rosalind Carter
    Division of Health Utilization and Policy Research, Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY 10032, U.S.A.
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  • Author Footnotes
    ✠ Dr Emily Mumford died after a long illness on 3 October, 1987. Her leadership as principal investigator in the earlier phases of the research is gratefully acknowledged. We regret her loss as a friend and a colleague.
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      A meta-analysis of the literature of controlled studies of educational and psychooocial interventions in the treatment of diabetes mellitus yielded 93 studies of 7451 patients testing the effects of eight intervention types: (1) didactic education, (2) enhanced education, (3) diet instruction, (4) exercise instruction, (5) self-monitoring instruction, (6) social learning/behavior modification, (7) counseling, and (8) relaxation training. An overall mean effect size (ES) of +0.51 ± 0.11 was found indicating moderate but significant (P < 0.05) improvements for all intervention subjects. Physical outcome and knowledge gain were most affected, followed by psychological status and compliance. Diet instruction and social learning interventions showed the strongest (ES = +0.68 ± 0.58 and ES = +0.57 ±0.42, respectively) and relaxation training the weakest (ES = +0.30 ± 0.74) effects. Associations between study and sample characteristics and mean ES values were explored with type of setting and methodological weaknesses such as single group design and non-random assignment achieving statistical significance. Neither intervention type, number of visits, sex, age, nor type of diabetes were significantly correlated with mean ES values. Implications of these findings for clinical treatment and future research are discussed.


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