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The Diabetes Educator, Vol. 34, No. 2, 242-265 (2008)
DOI: 10.1177/0145721708316551
© 2008 American Association of Diabetes Educators; Published by SAGE Publications

FEATURES

A Review of Systematic Reviews Evaluating Diabetes Interventions

Focus on Quality of Life and Disparities

Gayenell S. Magwood, PhD, MSN, RN, Jane Zapka, ScD and Carolyn Jenkins, DrPH, APRN-BCDM, CDE, RD, FAAN

From the College of Nursing (GSM, JZ, CJ) and the Department of Biostatistics, Bioinformatics and Epidemiology (JZ), Medical University of South Carolina, Charleston. Sponsored research: Resource Center for Minority Aging Research (RCMAR), National Institute on Aging, P30AG21677, Dr Barbara Tilley, principal investigator (PI); Racial and Ethnic Approaches to Community Health (REACH), Centers for Disease Control and Prevention, U50/CCU422184-04, Dr Carolyn Jenkins, PI.

Correspondence to Gayenell S. Magwood, PhD, MSN, RN, Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, PO Box 250160, Charleston, SC 29425 (magwoodg{at}musc.edu).

Purpose

This article reviews the literature on definitions and issues related to measurement of quality of life in people with diabetes and summarizes reviews of evidence of intervention studies, with a particular focus on interventions targeted for underserved and minority populations.

Methods

An integrative literature review of reviews was conducted on adult diabetes interventions and outcomes. Five electronic databases were searched. Eligible publications were those published between 1999 and 2006 that described outcome measures. Twelve review articles are included.

Results

Review studies were heterogeneous in terms of intervention type, content, participants, setting, and outcome measures. Interventions used variable operational definitions and frequently lacked adequate description; therefore, comparisons of findings proved difficult. A clinical outcome, A1C, was the most frequently assessed, with little inclusion of quality-of-life measures. Several reviews and independent studies did not explicitly consider interventions aimed at the underserved. When quality of life was considered, measures and operational definition of domains were limited.

Conclusions

Understanding the relationship between interventions and resulting outcomes, particularly quality of life, will require attention to operational definitions and better conceptual models. There is an evidence base emerging about important characteristics of effective intervention programs. This evidence base can guide public health and clinical program planners to better understand and make prudent decisions about assessment, planning, implementation, and evaluation of interventions for people with complex chronic illnesses such as diabetes.


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