Clinician Article

Effectiveness of lay-led, group-based self-management interventions to improve glycated hemoglobin (HbA1c), self-efficacy, and emergency visit rates among adults with type 2 diabetes: A systematic review and meta-analysis.

  • Tay JHT
  • Jiang Y
  • Hong J
  • He H
  • Wang W
Int J Nurs Stud. 2021 Jan;113:103779. doi: 10.1016/j.ijnurstu.2020.103779. Epub 2020 Sep 24. (Review)
PMID: 33080479
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  • Endocrine
    Relevance - 5/7
    Newsworthiness - 4/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 4/7
    Newsworthiness - 3/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 4/7
    Newsworthiness - 3/7


BACKGROUND: Diabetes is a debilitating health condition that is rapidly increasing in prevalence globally. Diabetes self-management is known as an important aspect of diabetes care, and group-based self-management interventions led by lay leaders have been explored previously. However, the effects of such an interventional approach to improve glycated hemoglobin (HbA1c) levels, self-efficacy, and emergency visit rates among adults with type 2 diabetes remains inconclusive.

OBJECTIVES: To review and perform a meta-analysis systematically of the effectiveness of lay-led, group-based self-management interventions to improve HbA1c levels, self-efficacy, and frequency of emergency visit rates in adults with type 2 diabetes.

METHODS: A systematic literature search was conducted through the following seven databases: PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, SCOPUS, and Web of Science. Screening and assessment for risk of bias were conducted by two independent reviewers. Meta-analyses were performed for HbA1c levels, self-efficacy, and frequency of emergency visits, using RevMan 5.3 software.

RESULTS: Sixteen randomized controlled trials were included in this review. Meta-analyses results indicated significant effects on HbA1c (pooled MD = 0.23, 95% CI [-0.41, -0.05], p = 0.01) self-efficacy (d = 0.27; 95% CI [0.19, 0.36]; p <0.00001), and frequency of emergency visits (pooled MD = 0.15; 95% CI [-0.26, -0.05]; p = 0.004], favoring the intervention groups. However, possible publication bias was detected. Significant heterogeneity was observed for HbA1c but not for self-efficacy or frequency of emergency visits.

CONCLUSIONS: Possible effects of lay-led, group-based self-management interventions on improving HbA1c, self-efficacy, and frequency of emergency visits among adults with type 2 diabetes were demonstrated in this review. Although possible publication bias and heterogeneity were detected for HbA1c, the results point toward a potentially feasible and effective treatment for adults with type 2 diabetes, allowing them to manage and sustain self-care behaviors.

Clinical Comments


This study is more relevant to clinical nurses but not doctors.


It would be helpful to know how long the benefits were sustained - the follow up is 1 year in all the studies in this meta-analysis.

General Internal Medicine-Primary Care(US)

It is unclear which part of the intervention actually works. My bias is that almost anything that shows that someone takes a personal interest in what the diabetic does to manage their disease improves control, whether it is a lay-person or a medical professional. In a chronic disease requiring repetitive attention to al of the details of management a "nudge" may be a critical piece of improved management.

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