An evaluation of the effectiveness of self‐management interventions for people with type 2 diabetes after an acute coronary syndrome: a systematic review

Background
Type 2 diabetes is highly prevalent in patients with acute coronary syndrome and impacts negatively on health outcomes and self‐management. Both conditions share similar risk factors. However, there is insufficient evidence on the effectiveness of combined interventions to promote self‐management behaviour for people with diabetes and cardiac problems. Identifying critical features of successful interventions will inform future integrated self‐management programmes for patients with both conditions.

Objectives
To assess the evidence on the effectiveness of existing interventions to promote self‐management behaviour for patients presenting with acute coronary syndrome and type 2 diabetes in secondary care settings and postdischarge.

Design
We searched MEDLINE , PubMed, CINAHL Plus, PsycInfo, Cochrane Library and AMED for randomised controlled trials published between January 2005–December 2014. The search was performed using the following search terms of ‘acute coronary syndrome’, ‘type 2 diabetes’ and ‘self‐management intervention’ and their substitutes combined.

Results
Of 4275 articles that were retrieved, only four trials met all the inclusion criteria (population, intervention, comparison and outcome) and were analysed. Overall, the results show that providing combined interventions for patients with both conditions including educational sessions supported by multimedia or telecommunication technologies was partially successful in promoting self‐management behaviours. Implementation of these combined interventions during patient's hospitalisation and postdischarge was feasible. Intervention group subjects reported a significant improvement in self‐efficacy, level of knowledge, glycated haemoglobin, blood pressure and fasting glucose test. However, there are many threats have been noticed around internal validity of included studies that could compromise the conclusions drawn.

Conclusion
With limited research in this area, there was no final evidence to support effectiveness of combined interventions to promote self‐management behaviour for patients with type 2 diabetes and acute coronary syndrome. Sufficiently powered, good quality, well‐conducted and reported randomised controlled trials are required.