Advertisement
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
    Correspondence
    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.
    Affiliations
    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.
    Search for articles by this author
  • Emily Mumford
    Footnotes
    Affiliations
    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.
    Search for articles by this author
  • Margaret Hynes
    Affiliations
    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.
    Search for articles by this author
  • Rosalind Carter
    Affiliations
    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.
    Search for articles by this author
  • 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.
DOI:https://doi.org/10.1016/0895-4356(88)90040-6
Meta-analysis of the effects of educational and psychosocial interventions on management of diabetes mellitus
Previous ArticleSentinel health events surveillance in diabetes Deaths among persons under age 45 with diabetes
Next ArticlePrognostic factors for life expectancy in multiple sclerosis analysed by
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      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.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Clinical Epidemiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • American Diabetes Association
        Third-party reimbursement of outpatient education and nutrition counseling.
        Diabetes Care. 1984; 7: 505-506
        • Kaplan R.M.
        • Davis W.K.
        Evaluating the costs and benefits of outpatient diabetes education and nutrition counseling.
        Diabetes Care. 1986; 9: 81-86
        • Graber A.L.
        • Christman B.G.
        • Alogna M.I.
        • Davidson J.K.
        Evaluation of diabetes patient education programs.
        Diabetes. 1977; 26: 61-64
        • Jovanovic L.
        • Peterson C.M.
        A comparison of eight educational programs.
        Diabetes Ed. 1984; : 40-42
        • Alogna M.
        CDC Diabetes control programsoverview of diabetes patient education.
        Diabetes Ed. 1985; : 32-36
        • Posavac E.J.
        Evaluations of patient education programs: a meta-analysis.
        Eval Health. 1980; 3: 47-62
        • Mazzuca S.A.
        Does patient education in chronic disease have therapeutic value?.
        J Chron Dis. 1982; 35: 521-529
        • Mullen P.D.
        • Green L.W.
        • Persinger G.S.
        Clinical trials of patient education for chronic conditions: A comparative meta-analysis of intervention types.
        Prev Med. 1985; 14: 753-781
        • Haynes R.B.
        Determinants of compliance: The disease and mechanics of treatment.
        in: Haynes R.B. Taylor D.W. Sackett D.L. Compliance and Health Care. The Johns Hopkins University Press, Baltimore1976
        • Cohen J.
        A coefficient of agreement for nominal scales.
        Edue Psychol Meas. 1960; 20: 37-46
        • Glass G.V.
        • McGaw B.
        • Smith M.L.
        Meta-analysis in Social Research.
        Sage Publications, Beverly Hills1981
        • Sackett D.L.
        • Haynes B.R.
        Compliance with Therapeutic Regimens.
        The Johns Hopkins University Press, Baltimore1976
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        Academic Press, New York1977
        • Hedges L.V.
        • Olkin I.
        Statistical Methods of MetaAnalysis.
        Academic Press, Orlando1985
        • Arakelian M.T.
        An investigation of the effects of an internalization intervention on compliance in adult diabetics.
        (Unpublished DSN Dissertation) Boston University, Massachusettes1984
        • Barnard R.J.
        • Massey M.R.
        • Cherny S.
        • O'Brien L.T.
        • Pritikin N.
        Long-term use of a high-complexcarbohydrate, high-fiber, low-fat diet and exercise in the treatment of NIDDM patients.
        Diabetes Care. 1983; 6: 268-273
        • Barnard J.
        • Lattimore L.
        • Holly R.G.
        • Cherny S.
        • Pritikin N.
        Response of non-insulin-dependent diabetic patients to an intensive program of diet and exercise.
        Diabetes Care. 1982; 5: 370-374
        • Barnard M.U.
        Glycosylated hemoglobin feedback profile as one behavioral strategy for improving adherence to long-term regimens: insulin dependent diabetes mellitus.
        (Unpublished Ph.D Dissertation) University of Kansas, 1985
        • Gerger M.
        Evaluation of a teaching and treatment programme for type I diabetic patients.
        Diabetes Educ. 1984; : 36-38
        • Mulhauser I.
        • Jorgens V.
        • Berger M.
        • Graninger W.
        • Gurtler W.
        • Hornke L.
        • Kunz A.
        • Schernthaner G.
        • Scholz V.
        • Voss H.E.
        Bicentric evaluation of a teaching and treatment programme for Type I (insulindependent) diabetic patients: Improvement of metabolic control and other measures of diabetes care for up to 22 months.
        Diabetologia. 1983; 25: 470-476
        • Bloomgarden Z.T.
        • Karmally W.
        • Metzger M.J.
        • Brothers M.
        • Nechemias C.
        • Bookman J.
        • Faierman D.
        • Ginsberg F.
        • Rayfield E.
        • Brown W.V.
        A randomized controlled trial of diabetic patient education: Improved knowledge without improved metabolic status.
        (Unpublished paper) Mount Sinai School of Medicine, New York1983
        • Buysschaert M.
        • Lepair-Gadisseux N.
        • Weil R.
        • Vandeleene B.
        • Leonet J.
        • Lambert A.E.
        Effect on an in-patient education programme upon the knowl edge, behavior and glycaemic control of insulin dependent diabetic patients.
        Diabete Metab. 1987; 13: 31-36
        • Cafiero M.
        An expanding role of the social worker in the changing health care system.
        1985 (Unpublished DSW Dissertation. The City University of New York)
        • Campaigne B.N.
        • Landt W.
        • Mellies M.J.
        • James F.W.
        • Glueck C.J.
        • Sperling M.A.
        The effects of physical training on blood lipid profiles in adolescents with insulin-dependent diabetes mellitus.
        Physician Sportsmed. 1985; 13: 83-89
        • Caron D.
        • Poussier P.
        • Marliss E.B.
        • Zinman B.
        The effect of postprandial exercise on meal-related glucose intolerance in insulin-dependent diabetic individuals.
        Diabetes Care. 1982; 5: 364-369
        • Chandalia H.B.
        • Bagrodia J.
        Effect of nutritional counseling on the blood glucose and nutritional knowledge of diabetic subjects.
        Diabetes Care. 1979; 2: 353-356
        • Cohen M.
        • Zimmet P.
        Self-monitoring of blood glucose levels in non-insulin-dependent diabetes mellitus.
        Med J Aust. 1983; 2: 377-380
        • Conti A.
        • Petruzzi E.
        • Mecca M.
        • Bucalossi A.
        Istruzione del diabetico: Esperienze nel day hospital.
        Rass Geriatrica. 1980; 16: 173-179
        • Daneman D.
        • Epstein L.H.
        • Siminerio L.
        • Beck S.
        • Farkas G.
        • Figueroa J.
        • Becker D.
        • Drash A.L.
        Effects of enhanced conventional therapy on metabolic control in children with insulin-dependent diabetes mellitus.
        Diabetes Care. 1982; 5: 472-478
        • Epstein L.H.
        • Beck S.
        • Figueroa J.
        • Farkas G.
        • Kazdin A.E.
        • Daneman D.
        • Becker D.
        The effects of targeting improvements in urine glucose on metabolic control in children with insulin dependent diabetes.
        J Appl Anal. 1981; 14: 365-375
        • de Bont A.J.
        • Baker I.A.
        • St Leger A.S.
        • Sweetnam P.M.
        • Wragg K.G.
        • Stephens S.M.
        • Hayes T.M.
        A randomised controlled trial of the effect of low fat diet advice on dietary response in insulin independent diabetic women.
        Diabetologia. 1981; 21: 529-533
        • Dupuis A.
        Assessment of the psychological factors and responses in self-managed patients.
        Diabetes Care. 1980; 3: 117-120
        • Dupuis A.
        • Jones R.L.
        • Peterson C.M.
        Psychological effects of blood glucose self-monitoring in diabetic patients.
        Psychosomatics. 1980; 21: 581-591
        • Epstein L.H.
        • Figueroa J.
        • Farkas G.M.
        • Beck S.
        The short-term effects of feedback on accuracy of urine glucose determinations in insulin dependent diabetic children.
        Behav Ther. 1981; 12: 560-564
        • Erle G.
        • Erle H.C.
        Diabetici adulti ed anziani in un campo estive: Valutazion degli aspetti piscologici e sociali in relazione al tipo di diabete ed alla ac cetazione della malattia.
        Assoc Med Diabetol. 1983; : 108-113
        • Falkenberg M.G.K.
        • Elwing B.E.
        • Goransson A.M.
        • Hellstrand B.E.S.
        • Riis U.M.
        Problem oriented participatory education in the guidance of adults with non-insulin-treated Type-II diabetes mellitus.
        Scand J Prim Health Care. 1986; 4: 157-164
        • Feinglos M.N.
        • Hastedt R.D.
        • Surwit R.S.
        Effects of relaxation therapy on patients with type I diabetes mellitus.
        Diabetes Care. 1987; 10: 72-75
        • Furman S.G.
        The effect of assertiveness training on locus of control and metabolic control of adolescents with diabetes mellitus.
        (Unpublished Ph.D. Dissertation) Nova University, Forida1983
        • Galatzer A.
        • Shoshana A.
        • Gil R.
        • Karp M.
        • Laron Z.
        Crisis intervention program in newly diagnosed diabetic children.
        Diabetes Care. 1982; 5: 414-419
        • Gates J.C.
        Comparison of behavior modification and self-help groups with conventional therapy of diabetes.
        (Unpublished Dr. P.H. Dissertation) University of California at Berkeley, 1979
        • Gilbert B.O.
        • Johnson S.B.
        • McCallum M.
        • Silverstein J.H.
        • Rosenbloom A.
        The effects of a peer-modeling film on children learning to self-inject insulin.
        Behav Ther. 1982; 13: 186-193
        • Grandguillaume P.
        • Micheli H.
        • Guidoux L.
        • Frey J.
        Effect of hypocholesterolemic diet on plasma lipids in diabetic children.
        Pediatr Adolesc Endocrinol. 1979; 7: 231-235
        • Gross A.M.
        • Heimann L.
        • Shapiro R.
        • Schultz R.M.
        Children with diabetes: Social skills training and hemoglobin Al c levels.
        Behav Modif. 1983; 7: 151-164
        • Harris J.A.
        Relaxation training as a stress-reducing technique for persons with diabetes.
        (Unpublished Ph.D. Dissertation) Vanderbilt University, Tennesse1980
        • Hartman P.Y.
        The effects of relaxation therapy and cognitive coping skills training on the control of diabetes mellitus.
        (Unpublished Ph.D. Dissertation) Kent State University, Ohio1982
        • Hartwell S.L.
        • Kaplan R.M.
        • Wallace J.P.
        Comparison of behavior interventions for control of type II diabetes mellitus.
        Behav Ther. 1986; 17: 447-461
        • Howard M.
        • Barnett C.
        • Chon M.
        • Wolf M.
        Retention of knowledge and self-care skills after an intensive in-patient diabetes education program.
        Diabetes Res Clin Prac. 1986; 2: 51-57
        • Ikeda Y.
        • Tajima N.
        • Minami N.
        • Ide Y.
        • Yokoyama J.
        • Abe M.
        Pilot study of self-measurement of blood glucose using the dextrostix-eyetone system for juvenile-onset diabetes.
        Diabetologia. 1978; 15: 91-93
        • Irsigler K.
        • Bali-Taubald C.
        Self-monitored blood glucose: The essential biofeedback signal in the diabaetic patient's effort to achieve normoglycemia.
        Diabetes Care. 1980; 3: 163-170
        • Kaplan R.M.
        • Chadwick M.W.
        • Schimmel L.E.
        Social learning intervention to promote metabolic control in Type I diabetes mellitus: Pilot experiment results.
        Diabetes Care. 1985; 8: 152-155
        • Karlander S.G.
        • Kindstedt K.
        Effects of a formalized diabetes education.
        Acta Med Scand. 1983; 213: 41-43
        • Kemp S.F.
        • Canfield M.E.
        • Kearns F.S.
        • Elders M.J.
        The effect of short-term intervention on long-term diabetes management.
        J Arkansas Med Sue. 1986; 83: 241-244
        • Kennedy L.
        • Walshe K.
        • Hadden D.R.
        • Weaver J.A.
        • Buchanan K.D.
        The effect of intensive dietary therapy on serum high density lipoprotein cholesterol in patients with Type 2 (non-insulin-dependent) diabetes mellitus: A prospective study.
        Diabetologia. 1982; 23: 24-27
        • Kershaw C.J.
        Effects of visual imagery and relaxation on the psychophysiology of diabetic functioning.
        (Unpublished Ed.D. Dissertation) E. Texas State University, 1979
        • Koehler B.
        The effects of relaxation on psychological and physical measures in Diabetes Mellitus.
        (Unpublished Ph.D. Dissertation) St John's University, New York1981
        • Korhonen T.
        • Uusitupa M.
        • Antti A.
        • Kumpulainen T.
        • Siitonen O.
        • Voutilainen E.
        • Pyorala K.
        Efficacy of dietary instruction in newly diagnosed non-insulin dependent diabetic patients. Comparison of two different patient education regimens.
        (final report) Department of Medicine, Kuopio University Central Hospital;, Kuopio, Finland1986
        • Korhonen T.
        • Huttunen J.K.
        • Antti A.
        • Hentinen M.
        • Ihalainen O.
        • Majander H.
        • Siitonen O.
        • Uusitupa M.
        • Pyorala K.
        A controlled trial on the effects of patient education in the treatment of insulin-dependent diabetes.
        Diabetes Care. 1983; 6: 256-261
        • Lam K.S.L.
        • Ma J.T.C.
        • Chan E.Y.M.
        • Yeung R.R.T.
        Sustained improvement in diabetic control on long term self-monitoring of blood glucose.
        Diabetes Res Clin Prac. 1986; 2: 165-171
        • Lebovitz F.
        • Ellis III, G.J.
        • Skyler J.S.
        Performance of technical skills of diabetes management: Increased independence after a camp experience.
        Diabetes Care. 1978; 1: 23-26
        • Lefebvre R.J.
        • Houziaux M.O.
        • Godart C.
        • ScheenLavigne M.
        • Bartholome M.
        • Luyckx A.S.
        Computerassisted instruction for diabetics: An original project developed at the University of Liege, Belgium.
        Diabete Metab. 1981; 7: 127-134
        • Legge Jr, J.S.
        • Massey V.M.
        • Vena C.I.
        • Reilly B.J.
        Evaluating patient education: A case study of a diabetes program.
        Health Educ. 1980; 7: 148-158
        • Lipets M.S.
        The effects of juvenile diabetic camping on self-esteem and locus of control.
        (Unpublished Ph.D. Dissertation) Washington University, Mo1983
        • Lucey D.
        • Wing E.
        A clinic based educational programme for children with diabetes.
        Diabetic Med. 1985; 2: 292-295
        • Maras M.L.
        • Rinke W.J.
        • Stephens C.R.
        • Boehm T.M.
        Effect of meditation on insulin dependent diabetes mellitus.
        Diabetes Educ. 1984; : 22-25
        • Marrero D.G.
        Adjustment to misfortune: An intervention program to improve metabolic stability of insulin dependent diabetes mellitus in adolescents.
        (Unpublished Ph.D. Dissertation) University of California, Irvine1982
        • Maryniuk M.D.
        • Kauwell G.P.
        • Thomas R.G.
        A test of instructional approaches designed to influence food selection.
        Diabetes Educ. 1986; : 34-36
        • Mazze R.S.
        • Lucido D.
        • Shamoon H.
        Psychological and social correlates of glycemic control.
        Diabetes Care. 1984; 7: 360-366
        • Mazzuca S.A.
        • Moorman N.H.
        • Wheeler M.L.
        • Norton J.A.
        • Fineberg N.S.
        • Vinicor F.
        • Cohen S.J.
        • Clark Jr., C.M.
        The diabetes education study: A controlled trial of the effects of diabetes patient education.
        Diabetes Care. 1986; 9: 1-10
        • McCulloch D.K.
        • Mitchell R.D.
        • Jambler J.
        • Tattersall R.B.
        Influence of imaginative teaching of diet on compliance and metabolic control in insulin dependent diabetes.
        Br Med J. 1983; 287: 1858-1861
        • Minuk H.L.
        • Vranic M.
        • Marliss E.B.
        • Hanna A.K.
        • Albisser A.M.
        • Zinman B.
        Glucoregulatory and metabolic response to exercise in obese noninsulindependent diabetes.
        Am Physio Soc. 1981; : E458-E464
        • Moffatt M.E.K.
        • Pless I.B.
        Locus of control in juvenile diabetic campers: Changes during camp, and relationship to camp staff assessments.
        J Pediatr. 1983; 103: 146-150
        • Moses J.L.
        • Bradley C.
        Accuracy of subjective blood glucose estimation by patients with insulin-dependent diabetes.
        Biofeedback Self Regul. 1985; 10: 301-314
        • Muhlhauser I.
        • Broermann Ch.
        • Bartels H.
        • Berg R.
        • Schwarz S.
        • Berger M.
        Qualitatskontrolle der Blutzuckerselbstmessung bei unausgewahlten typ-Idiabetikern: Bedeutung der patientenschlulung.
        Dtsch Med Wochenschr. 1983; 41: 1553-1557
        • Mulrow C.
        • Bailey S.
        • Sonksen P.H.
        • Slavin B.
        Intensive education is not enough: Negative results of a randomized trial.
        (Unpublished article presented at the Southern section)in: Society for Research and Education in Primary Care Internal Medicine Meeting, Jan., 19861986 (and the National Meeting)
        • Powell M.F.
        • de P. Burkhart V.
        • Lamy P.P.
        Diabetic patient compliance as a function of patient counseling.
        Drug Intell Clin Pharm. 1979; 13: 506-511
        • Power L.
        Group approach to diabetes care.
        Postgrad Med. 1983; 73: 211-216
        • Prater B.M.
        The child/adolescent with diabetes mellitus: A descriptive and follow-up cohort study.
        (Unpublished Ph.D. Dissertation) The University of Utah, 1980
        • Pratt C.
        • Wilson W.
        • Leklem J.
        • Kingsley L.
        The effects of nutrition education, peer support, and patients' beliefs upon weight and glycemic control among older noninsulin-dependent diabetic patients.
        J Nutr Educ Elderly. 1988; (In press)
        • Rabkin S.W.
        • Boyko E.
        • Wilson A.
        • Streja D.
        A randomized clinical trial comparing behavior modification and individual counseling in the nutri tional therapy of non-insulin-dependent diabetes mellitus: Comparison of the effect on blood sugar, body weight, and serum lipids.
        Diabetes Care. 1983; 6: 50-56
        • Rettig B.
        • Shrauger D.G.
        • Recker R.R.
        • Gallagher T.F.
        • Wiltse H.
        A randomized study of the effects of a home diabetes education program.
        Diabetes Care. 1986; 9: 173-178
        • Rose M.I.
        • Firestone P.
        • Heick H.M.C.
        • Faught A.K.
        The effects of anxiety management training on the control of juvenile diabetes mellitus.
        J Behav Med. 1983; 6: 381-395
        • Rosenbuam L.
        Biofeedback-assisted stress management for insulin-treated diabetes mellitus.
        Biofeedback Self Regul. 1983; 8: 519-532
        • Rubin R.
        Evaluation of an intensive diabetes education program incorporating coping skills training.
        (Unpublished)in: Presented to The American Association of Diabetes Educators as a mini lecture. 1986
        • Ruderman N.B.
        • Ganda O.M.P.
        • Johansen K.
        The effect of physical training on glucose tolerance and plasma lipids in maturity-onset diabetes.
        Diabetes. 1979; 28: 89-92
        • Schiffrin A.
        • Belmonte M.
        Multiple daily self-glucose monitoring: Its essential role in long-term glucose control in insulin-dependent diabetic patients treated with plump and multiple subcutaneous injections.
        Diabetes Care. 1982; 5: 479-484
        • Schreiber J.
        • Amos R.J.
        Hospital diabetes education: Classroom and self-instruction.
        J Am Diet Assoc. 1983; 83: 581-583
        • Scott R.
        • Beaven D.W.
        • Stafford J.M.
        The effectiveness of diabetes education for non-insulin dependent diabetic persons.
        Diabetes Educ. 1984; : 36-39
        • Simon K.
        Short-term experiences in education of diabetes.
        1982 (Unpublished paper. Hungary)
        • Smith D.M.
        • Norton J.A.
        • Weinberger M.
        • Mcdonald C.J.
        • Katz B.P.
        Increasing prescribed office visits: A controlled trial in patients with diabetes mellitus.
        Med Care. 1986; 24: 189-199
        • Spalding R.H.
        • Spaulding W.B.
        The diabetic day-care unit. II. Comparison of patients and costs of initiating insulin therapy in the unit and a hospital.
        Can Med Assoc J. 1976; 114: 780-783
        • Stanik S.
        • Marcus R.
        Insulin secretion improves following dietary control of plasma glucose in severely hyperglycemic obsese patients.
        Metabolism. 1980; 29: 346-350
        • Stevens J.
        • Burgess M.B.
        • Kaiser D.L.
        • Sheppa C.M.
        Outpatient management of diabetes mellitus with patient education to increase dietary carbohydrate and fiber.
        Diabetes Care. 1985; 8: 359-366
        • Stevens L.C.
        Programs and meta programs for the control of diabetes symptomotology: A comparative study.
        (Unpublished Ph.D. Dissertation) N. Texas State University, 1983
        • Streja D.
        • Boyko E.
        • Rabkin S.W.
        Nutrition therapy in non-insulin-dependent diabetes mellitus.
        Diabetes Care. 1981; 4: 81-84
        • Surwit R.S.
        • Feinglos M.N.
        The effects of relaxation on glucose tolerance in non-insulin-dependent diabetes.
        Diabetes Care. 1983; 6: 176-179
        • Taylor K.G.
        • John W.G.
        • Matthews K.A.
        • Wright A.D.
        A prospective study of the effect of 12 months treatment on serum lipids and apolipoproteins A-1 and B in Type 2 (non-insulin-dependent) diabetes.
        Diabetologia. 1982; 23: 507-510
        • Terent A.
        • Hagfall O.
        • Cederholm U.
        The effect of education and self-monitoring of blood glucose on glycosylated hemoglobin in Type I diabetes.
        Acta Med Scand. 1985; 217: 47-53
        • Visher J.W.
        Changes in behavior, anxiety, and mood in diabetics following participation in “Dynamics for Diabetics”.
        (Unpublished Ph.D. Dissertation) California School of Professional Psychology, Berkeley1979
        • Wallberg-Henriksson H.
        • Gunnarsson R.
        • Henriksson J.
        • Defronzo R.
        • Felig P.
        • Ostman J.
        • Wahren J.
        Increased peripheral insulin sensitivity and muscle mito chondrial enzymes but unchanged blood glucose control in type I diabetics after physical training.
        Diabetes. 1982; 31: 1044-1050
        • Webb K.L.
        • Dobson A.J.
        • O'Connell D.L.
        • Tupling H.E.
        • Harris G.W.
        • Atkinson Moxon J.
        • Sulway M.J.
        • Leeder S.R.
        Dietary compliance among insulin dependent diabetics.
        J Chron Dis. 1984; 37: 633-643
        • Werdier D.
        • Jesdinsky H.J.
        • Helmich P.
        A randomized, controlled study on the effect of diabetes counseling in the offices on 12 general practitioners.
        Rev Epidemiol Med Same Publique. 1984; 32: 225-229
        • Wheeler L.A.
        • Wheeler M.L.
        • Ours P.
        • Swider C.
        Evaluation of computer-based diet education in persons with diabetes mellitus and limited educational background.
        Diabetes Care. 1985; 8: 537-544
        • White N.
        • Carnahan J.
        • Nugent C.A.
        • Iwaoka T.
        • Dodson M.A.
        Management of obese patients with diabetes mellitus: Comparison of advice education with group management.
        Diabetes Care. 1986; 9: 490-496
        • White N.
        An empirical test of a theoretical model to explain adherence to a diabetic therapeutic regimen.
        (Unpublished Ph.D. Dissertation) University of Arizona, 1985
        • Whitehouse F.W.
        • Whitehouse I.J.
        • Cox M.S.
        • Goldman J.
        • Kahkonen D.M.
        • Partamian J.O.
        • Tamayo R.C.
        Outpatient regulation of the insulin-requiring person with diabetes (An alternative to hospitalization.
        J Chron Dis. 1983; 36: 433-438
        • Whitehouse F.W.
        • Whitehouse I.J.
        • Smith J.
        • Hohl R.
        Teaching the person with diabetes: Experience with a follow-up session.
        Diabetes Care. 1979; 2: 35-38
        • Williams J.R.
        • Alling K.
        A program for normal glycemic control of insulin-dependent diabetes.
        Diabetes Care. 1986; 3: 160-162
        • Wilson D.P.
        • Endres R.K.
        Compliance with blood glucose monitoring in children with type 1 diabetes mellitus.
        J Pediatr. 1986; 108: 1022-1024
        • Wing R.R.
        • Epstein L.H.
        • Nowalk M.P.
        • Scott N.
        • Koeske R.
        • Hagg S.
        Behavior change, weight loss, and physiological improvements in type II diabetic patients.
        J Consult Clin Psychol. 1985; 53: 111-112
        • Wing R.R.
        • Nowalk M.P.
        • Epstein L.H.
        • Scott N.
        • Koeske R.
        Calorie-counting compared to exchange system diets in the treatment of overweight patients with type II diabetes.
        Addic Behav. 1986; 11: 163-168
        • Wing R.R.
        • Epstein L.H.
        • Nowalk M.P.
        • Scott N.
        • Koeske R.
        • Hagga S.
        Does self-monitoring of blood glucose levels improve dietary compliance for obese patients with type 11 diabetes?.
        Am J Med. 1986; 81: 830-836
        • Wise P.H.
        • Dowlatshahi D.C.
        • Farrant S.
        • Fromson S.
        • Meadows K.A.
        Effect of computer-based learning on diabetes knowledge and control.
        Diabetes Care. 1986; 9: 504-508
        • Worth R.
        • Home P.D.
        • Johnston D.G.
        • Anderson J.
        • Ashworth L.
        • Burrin J.M.
        • Appleton D.
        • Binder C.
        • Alberti K.G.M.M.
        Intensive attention improves glycaemic control in insulin-dependent diabetes without further advantage from home blood glucose monitoring: results of a controlled trial.
        Br Med J. 1982; 285: 1233-1240
        • Zaremba M.
        Impact of diabetes education on diabetics hospitalized for diabetic ketoacidosis (DKA) coma.
        (Unpublished paper presented at the American Diabetes Association)in: 43rd Annual Meeting of Scientific Sessions, San Antonio, Texas1983
        • Bandura A.
        Social Learning Theory.
        Prentice Hall, Engelwood Cliffs, New Jersey1977
        • West K.M.
        Epidemiology of Diabetes and its Vascular Lesions.
        Elsevier, New York1978
        • National Diabetes Data Group
        Diabetes in America.
        (U.S. Department of Health and Human Services, Public Health Service, National Institute of Arthritis, Diabetes, Digestive, and Kidney Diseases) U.S. Govermnment Printing Office, Washington DC1985

      Article info

      Publication history

      Accepted: March 21, 1988

      Footnotes

      ☆This research was supported by a grant from the New York State Health Research Council (Contract No. C001885).

      Identification

      DOI: https://doi.org/10.1016/0895-4356(88)90040-6

      Copyright

      © 1988 Published by Elsevier Inc.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX