| 1. Self-management behaviours / Foot care |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| -0.1 [-0.7, 0.5] |
Very low |
It may result in little to no difference in foot care self-management but the evidence is very uncertain |
1 |
47 |
-0.1 [-0.7, 0.5] |
Low |
0.0 |
NA [NA, NA] |
NA |
| 2. Quality of life / Psychological distress |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| 0.19 [-0.39, 0.78] |
Very low |
It may result in little to no difference in psychological distress but the evidence is very uncertain |
1 |
311 |
0.19 [-0.39, 0.78] |
Low |
0.0 |
NA [NA, NA] |
NA |
| 3. Self-efficacy |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| 0.0 [-0.67, 0.67] |
Very low |
It may result in little to no difference in self-efficacy |
2 |
630 |
0.0 [-0.67, 0.67] |
Low |
0.0 |
NA [NA, NA] |
NA |
| 4. Weight (management) / Waist size |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| -0.63 [-2.68, 1.42] |
Low |
It may result in little to no difference in waist size (cm) |
1 |
178 |
-0.63 [-2.68, 1.42] |
Low |
0.0 |
NA [NA, NA] |
NA |
| 5. Lipid profile / LDL-Cholesterol |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| -15.47 [-25.71, -5.23] |
Moderate |
It likely results in little to no difference in LDL levels (mg/dL) |
1 |
178 |
-15.47 [-25.71, -5.23] |
Moderate |
0.0 |
NA [NA, NA] |
NA |
| 6. Quality of life |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| -0.19 [-0.75, 0.37] |
Very Low |
It may result in little to no difference in quality of life |
2 |
616 |
-0.19 [-0.75, 0.37] |
Low |
0.0 |
NA [NA, NA] |
NA |
| 7. Lipid profile / HDL-Cholesterol (mmol) |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| -1.16 [-5.54, 3.22] |
Moderate |
It likely results in a large increase in HDL levels (mmol/L) |
1 |
178 |
-1.16 [-5.54, 3.22] |
Moderate |
0.0 |
NA [NA, NA] |
NA |
| 8. Lipid profile / Triglycerides |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| 0.07 [-0.64, 0.78] |
Moderate |
It likely results in little to no difference in triglycerides (mmol/L) |
1 |
178 |
0.07 [-0.64, 0.78] |
Moderate |
0.0 |
NA [NA, NA] |
NA |
| 9. Lipid profile / Total cholesterol |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| -7.3 [-17.42, 2.82] |
Low |
It may result in little to no difference in total cholesterol (mg/dL) |
2 |
319 |
-7.3 [-17.42, 2.82] |
Low |
0.0 |
NA [NA, NA] |
NA |
| 10. Blood-pressure / Diastolic pressure |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| -5.42 [-10.12, -0.72] |
Very low |
It may decrease diastolic blood pressure(mmHg) but the evidence is very uncertain |
1 |
178 |
-5.42 [-10.12, -0.72] |
Low |
0.0 |
NA [NA, NA] |
NA |
| 11. Blood-pressure / Systolic pressure |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| -6.84 [-12.37, -1.32] |
Very low |
It may decrease systolic blood pressure levels (mmHg) but the evidence is very uncertain |
2 |
319 |
-6.84 [-12.37, -1.32] |
Very low |
0.0 |
NA [NA, NA] |
NA |
| 12. Weight (management) / BMI - Body Mass Index |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| -0.6 [-2.27, 1.07] |
Low |
It may result in little to no difference in body mass index (kg/m²) |
1 |
141 |
-0.6 [-2.27, 1.07] |
Low |
0.0 |
NA [NA, NA] |
NA |
| 13. HbA1C / Glycated hemoglobin (HbA1c) |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| -0.25 [-0.7, 0.19] |
Very Low |
It may result in little to no difference in HbA1C levels (%) but the evidence is very uncertain |
3 |
319 |
-0.25 [-0.7, 0.19] |
Very low |
0.0 |
NA [NA, NA] |
NA |
Footnotes per outcome:
1) a) We rated down the certainty of evidence due to very serious risk of bias and serious imprecision; b) Number of studies included in the network: 26 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=25); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 2 to 24 months for the studies included in the whole network. The range of follow-up was 3 months in the studies directly comparing the self-management intervention versus usual care.
2) a) We rated down the certainty of evidence due to very serious risk of bias and serious imprecision; b) Number of studies included in the network: 44 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=204); Number of comparison(s) informing the indirect estimate: 0 comparison(s).The range of follow up was from 2 to 24 months for the studies included in the whole network. The range of follow-up was 6 months in the studies directly comparing the self-management intervention versus usual care.
3) a) We rated down the certainty of evidence due to very serious risk of bias and very serious imprecision; b) Number of studies included in the network: 55 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=414); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 1 to 24 months for the studies included in the whole network. The range of follow-up was 6 months in the studies directly comparing the self-management intervention versus usual care.
4) a) Number of studies included in the network: 81 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=89); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 1 to 36 months for the studies included in the whole network. The range of follow-up was 18 months in the studies directly comparing the self-management intervention versus usual care.; b) We rated down the certainty of evidence due to very serious risk of bias and very serious risk of bias
5) a) We rated down the certainty of evidence due to serious risk of bias; b) Number of studies included in the network: 171 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=89); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 1 to 96 months for the studies included in the whole network. The range of follow-up was 18 months in the studies directly comparing the self-management intervention versus usual care.
6) a) Number of studies included in the network: 81 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=406); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 1 to 60 months for the studies included in the whole network. The range of follow-up was 6-6 months in the studies directly comparing the self-management intervention versus usual care.; b) We rated down the certainty of evidence due to serious imprecision and very serious risk of bias
7) a) We rated down the certainty of evidence due to serious risk of bias; b) Number of studies included in the network: 162 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=89); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 1 to 96 months for the studies included in the whole network. The range of follow-up was 18 months in the studies directly comparing the self-management intervention versus usual care.
8) a) Number of studies included in the network: 171 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=89); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 1 to 96 months for the studies included in the whole network. The range of follow-up was 18 months in the studies directly comparing the self-management intervention versus usual care.; b) We rated down the certainty of evidence due to serious risk of bias
9) a) Number of studies included in the network: 176 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=155); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 1 to 96 months for the studies included in the whole network. The range of follow-up was 18-24 months in the studies directly comparing the self-management intervention versus usual care.; b) We rated down the certainty of evidence due to serious risk of bias and to serious inconsistency
10) a) Number of studies included in the network: 211 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=89); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 1 to 96 months for the studies included in the whole network. The range of follow-up was 18 months in the studies directly comparing the self-management intervention versus usual care.; b) We rated down the certainty of evidence due to very serious risk of bias and serious imprecision
11) a) We rated down the certainty of evidence due to serious imprecision, very serious risk of bias and serious inconsistency; b) Number of studies included in the network: 233 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=155); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 1 to 96 months for the studies included in the whole network. The range of follow-up was 18-24 months in the studies directly comparing the self-management intervention versus usual care.
12) a) We rated down the certainty of evidence due to very serious risk of bias; b) Number of studies included in the network: 231 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=66); Number of comparison(s) informing the indirect estimate: 0 comparison(s).The range of follow up was from 1 to 96 months for the studies included in the whole network. The range of follow-up was 24 months in the studies directly comparing the self-management intervention versus usual care.
13) a) We rated down the certainty of evidence due to serious imprecision, very serious risk of bias and serious inconsistency; b) Number of studies included in the network: 463 RCTs; Number of studies directly comparing the intervention with usual care: 3 RCT(s) (N=155); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 1 to 96 months for the studies included in the whole network. The range of follow-up was 6-18 months in the studies directly comparing the self-management intervention versus usual care.
References of studies informing direct evidence:
1) McBride-2016
2) Denig-2014
3) Denig-2014, Schuling-2015
4) Crasto-2011
5) Lim-2011
6) Denig-2014, Schuling-2015
7) Crasto-2011
8) Crasto-2011
9) Crasto-2011, Den Ouden-2017
10) Crasto-2011
11) Crasto-2011Den Ouden-2017
12) Den Ouden-2017
13) Crasto-2011, Den Ouden-2017, Mathers-2012
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