, Volume 55, Issue 3, pp 712–731 | Cite as

Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis

  • Xiaoqin He
  • Jie Li
  • Bin Wang
  • Qiuming Yao
  • Ling Li
  • Ronghua Song
  • Xiaohong Shi
  • Jin-an ZhangEmail author



Diabetes self-management education is an essential part of diabetes care, but its impact on all-cause mortality risk of type 2 diabetes patients is unclear. A systematic review and meta-analysis aiming to elucidate the impact of diabetes self-management education on all-cause mortality risk of type 2 diabetes patients was performed.


Randomised controlled trials were identified though literature search in Medline, Embase, CENTRAL, conference abstracts, and reference lists. Only randomised controlled trials comparing diabetes self-management education with usual care in type 2 diabetes patients and reporting outcomes after a follow-up of at least 12 months were considered eligible. Risk ratios with 95 %CIs were pooled. This study was registered at PROSPERO with the number of CRD42016043911.


42 randomised controlled trials containing 13,017 participants were included. The mean time of follow-up was 1.5 years. There was no heterogeneity among those included studies (I 2 = 0 %). Mortality occurred in 159 participants (2.3 %) in the diabetes self-management education group and in 187 (3.1 %) in the usual care group, and diabetes self-management education significantly reduced risk of all-cause mortality in type 2 diabetes patients (pooled risk ratios : 0.74, 95 %CI 0.60–0.90, P = 0.003; absolute risk difference: −0.8 %, 95 %CI −1.4 to −0.3). Both multidisciplinary team education and nurse-led education could significantly reduce mortality risk in type 2 diabetes patients, and the pooled risk ratios were 0.66 (95 %CI 0.46–0.96, P = 0.02; I 2 = 0 %) and 0.64 (95 % CI 0.47– 0.88, P = 0.005; I 2 = 0 %), respectively. Subgroup analyses of studies with longer duration of follow-up (≥1.5 years) or larger sample size (≥300) also found a significant effect of diabetes self-management education in reducing mortality risk among type 2 diabetes. Significant effect of diabetes self-management education in reducing mortality risk was also found in those patients receiving diabetes self-management education with contact hours more than 10 h (pooled risk ratio: 0.60, 95 %CI 0.44–0.82, P = 0.001; I 2 = 0 %), those receiving repeated diabetes self-management education (pooled RR: 0.71, P = 0.001; I 2 = 0 %), those receiving diabetes self-management education using structured curriculum (pooled risk ratio: 0.72, P = 0.01; I 2 = 0 %) and those receiving diabetes self-management education using in-person communication (pooled risk ratio: 0.75, P = 0.02; I 2 = 0 %). The quality of evidence for the effect of diabetes self-management education in reducing all-cause mortality risk among type 2 diabetes patients was rated as moderate according to the Grading of Recommendations Assessment, Development, and Evaluation method, and the absolute risk reduction of all-cause mortality of type 2 diabetic patients by diabetes self-management education was estimated to be 4 fewer per 1000 person-years (from 1 fewer to 6 fewer).


The available evidence suggests that diabetes self-management education can reduce all-cause mortality risk in type 2 diabetes patients. Further clinical trials with longer time of follow-up are needed to validate the finding above.


Diabetes self-management education Type 2 diabetes All-cause mortality Meta-analysis 



We thank Prof. Zhang from Huadong Hospital of Fudan University for her helpful advice on our study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Supplementary material

12020_2016_1168_MOESM1_ESM.doc (124 kb)
Supplementary Information


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Xiaoqin He
    • 1
    • 2
  • Jie Li
    • 3
  • Bin Wang
    • 1
  • Qiuming Yao
    • 1
  • Ling Li
    • 1
  • Ronghua Song
    • 1
  • Xiaohong Shi
    • 1
  • Jin-an Zhang
    • 1
    Email author
  1. 1.Department of EndocrinologyJinshan Hospital of Fudan UniversityShanghaiChina
  2. 2.Shanghai Medical CollegeFudan UniversityShanghaiChina
  3. 3.Department of NephrologyXi’an Central HospitalXi’anChina

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