Personal Health Coaching as a Type 2 Diabetes Mellitus Self-Management Strategy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

摘要

Objective: Personal health coaching (PHC) programs have become increasingly utilized as a type 2 diabetes mellitus (T2DM) self-management intervention strategy. This article evaluates the impact of PHC programs on glycemic management and related psychological outcomes. Data Sources: Electronic databases (CINAHL, MEDLINE, PubMed, PsycINFO, and Web of Science). Study Inclusion and Exclusion Criteria: Randomized controlled trials (RCT) published between January 1990 and September 2017 and focused on the effectiveness of PHC interventions in adults with T2DM. Data Extraction: Using prespecified format guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Data Synthesis: Quantitative synthesis for primary (ie, hemoglobin A1c [HbA1c]) and qualitative synthesis for selected psychological outcomes. Results: Meta-analyses of 22 selected publications showed PHC interventions favorably impact HbA1c levels in studies with follow-ups at ≤3 months (?0.32% [95% confidence interval, CI = ?0.55 to ?0.09%]), 4 to 6 months (?0.50% [95% CI = ?0.65 to ?0.35%], 7 to 9 months (?0.66% [95% CI = ?1.04 to ?0.28%]), and 12 to 18 months (?0.24% [95% CI = ?0.38 to ?0.10%]). Subsequent subgroup analyses led to no conclusive patterns, except for greater magnitude of effect size in studies with conventional (2-arm) RCT design. Conclusions: The PHC appears effective in improving glycemic control. Further research is required to assess the effectiveness of specific program components, training, and supervision approaches and to determine the cost-effectiveness of PHC interventions.