Interventions With Adherence-Promoting Components in Pediatric Type 1 Diabetes Meta-analysis of their impact on glycemic control

OBJECTIVE — To review interventions with adherence-promoting components and docu-ment their impact on glycemic control via meta-analysis. RESEARCH DESIGNANDMETHODS — Data from 15 studies that met the following criteria were subjected to meta-analysis: 1) randomized, controlled trial, 2) study sample in-cluded youth aged19 years, 3) youth had type 1 diabetes, 4) study reported results on glycemic control; and 5) study reported use of adherence- or self-management–promoting components. RESULTS — The 15 studies included 997 youth with type 1 diabetes. The mean effect size for pre- to posttreatment change for the intervention versus control group comparison was 0.11 (95 % CI 0.01 to 0.23). This is a small effect, demonstrating very modest improvements in glycemic control. However, analysis for the pre- to posttreatment effects for the intervention group alone did show significant variability [Q(14) 33.11; P 0.05]. Multicomponent interventions, those that targeted emotional, social, or family processes that facilitate diabetes management, were more potent than interventions just targeting a direct, behavioral process (e.g., increase in blood glucose monitoring frequency). CONCLUSIONS — Interventions that focus on direct, behavioral processes and neglec