| 1. 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 |
| 0.32 [-0.44, 1.08] |
Very Low |
It may result in little to no difference in quality of life but the evidence is very uncertain |
0 |
0 |
[, ] |
NA |
4.0 |
0.32 [-0.44, 1.08] |
Low |
| 2. 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 |
| 1.77 [1.28, 2.27] |
Low |
It may result in a large increase in foot care self-management |
0 |
0 |
[, ] |
NA |
4.0 |
1.77 [1.28, 2.27] |
Low |
| 3. Self-management behaviours |
| 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 |
| 0.3 [-1.47, 2.07] |
Very low |
It may result in little to no difference in self-management behaviours |
0 |
0 |
[, ] |
NA |
2.0 |
0.3 [-1.47, 2.07] |
Low |
| 4. Hypoglycaemia |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
| 46.2 [-4.33, 120.17] |
Very low |
It may increase hypoglycaemic events |
0 |
0 |
[, ] |
NA |
1.0 |
0.65 [-1.91, 3.21] |
Very low |
| 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 |
| -6.11 [-15.28, 3.05] |
Low |
It may result in little to no difference in LDL levels (mg/dL) |
0 |
0 |
[, ] |
NA |
4.0 |
-6.11 [-15.28, 3.05] |
0 |
| 6. Self-monitoring / Glucose self-monitoring |
| 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 |
| 1.39 [0.04, 2.74] |
Very low |
It may increase glucose self-monitoring but the evidence is very uncertain |
0 |
0 |
[, ] |
NA |
4.0 |
1.39 [0.04, 2.74] |
Low |
| 7. Knowledge |
| 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 |
| 0.37 [-0.62, 1.37] |
Very low |
It may result in little to no difference in knowledge but the evidence is very uncertain |
0 |
0 |
[, ] |
NA |
3.0 |
0.37 [-0.62, 1.37] |
Low |
| 8. Dietary habits |
| 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 |
| 0.45 [-0.23, 1.12] |
Low |
It may result in little to no difference in dietary habits |
0 |
0 |
[, ] |
N/A |
4.0 |
0.45 [-0.23, 1.12] |
Low |
| 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 |
| 3.2 [-4.68, 11.08] |
Low |
It may result in little to no difference in total cholesterol (mg/dL) |
0 |
0 |
[, ] |
NA |
6.0 |
3.2 [-4.68, 11.08] |
Low |
| 10. 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 |
| 7.33 [2.4, 12.26] |
Low |
It may result in little to no difference in waist size (cm) |
0 |
0 |
[, ] |
NA |
20.0 |
7.33 [2.4, 12.26] |
Low |
| 11. Weight (management) / Weight (Kgs/lbs) |
| 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 |
| 5.84 [3.3, 8.38] |
Very low |
It may result in little to no difference in weight (kgs) but the evidence is very uncertain |
0 |
0 |
[, ] |
NA |
4.0 |
5.84 [3.3, 8.38] |
Low |
| 12. 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 |
| -0.33 [-1.1, 0.45] |
Very low |
It may result in little to no difference in psychological distress but the evidence is very uncertain |
0 |
0 |
[, ] |
NA |
4.0 |
-0.33 [-1.1, 0.45] |
Low |
| 13. Physical activity |
| 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 |
| -0.11 [-0.5, 0.27] |
Very low |
It may result in little to no difference in physical activity |
1 |
70 |
0.08 [-0.66, 0.82] |
Low |
6.0 |
-0.19 [-0.64, 0.26] |
Low |
| 14. Long-term complications / Long term complications |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
| -28.01 [-88.85, 1425.85] |
Very low |
It may slightly decrease long term complications incidence but the evidence is very uncertain |
1 |
35 |
-0.2229 [-2.5258, 2.08] |
Low |
0.0 |
N/A |
NA |
| 15. Adherence / Medication (or other treatment) adherence |
| 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 |
| 0.71 [-0.46, 1.89] |
Very low |
It may result in little to no difference in adherence |
1 |
70 |
0.91 [-0.35, 2.17] |
Low |
1.0 |
-0.62 [-3.92, 2.67] |
Low |
| 16. 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 |
| -0.91 [-3.49, 1.67] |
Very low |
It may result in little to no difference in diastolic blood pressure(mmHg) but the evidence is very uncertain |
1 |
35 |
2.03 [-4.97, 9.03] |
Low |
5.0 |
-1.37 [-4.14, 1.41] |
Low |
| 17. 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 |
| 1.74 [-1.27, 4.75] |
Moderate |
It likely results in a large decrease in HDL levels (mmol/L) |
1 |
109 |
5.8 [0.3, 11.3] |
Moderate |
6.0 |
0.01 [-3.59, 3.6] |
Moderate |
| 18. 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 |
| 1.4 [-3.33, 6.13] |
Very low |
It may decrease systolic blood pressure levels (mmHg) but the evidence is very uncertain |
1 |
35 |
5.52 [-5.19, 16.23] |
Low |
5.0 |
0.4 [-4.87, 5.67] |
Low |
| 19. 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 |
| 0.03 [-0.34, 0.41] |
Moderate |
It likely results in little to no difference in triglycerides (mmol/L) |
1 |
109 |
-0.52 [-1.14, 0.1] |
Moderate |
7.0 |
0.37 [-0.11, 0.84] |
Moderate |
| 20. 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 |
| 0.56 [-0.19, 1.3] |
Very low |
It may result in little to no difference in body mass index (kg/m²) but the evidence is very uncertain |
1 |
109 |
-2.0 [-4.19, 0.19] |
Low |
6.0 |
0.89 [0.1, 1.69] |
Low |
| 21. 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 |
| -0.42 [-0.66, -0.18] |
Low |
It may result in little to no difference in HbA1C levels (%) |
3 |
250 |
-1.46 [-1.96, -0.96] |
Moderate |
11.0 |
-0.09 [-0.37, 0.19] |
Moderate |
Footnotes per outcome:
1) a) Number of studies included in the network: 81 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: 4 comparison(s). The range of follow up was from 1 to 60 months for the studies included in the whole network; b) We rated down the certainty of evidence due to serious imprecision
2) a) We rated down the certainty of evidence due to very serious risk of bias; b) Number of studies included in the network: 26 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: 4 comparison(s). The range of follow up was from 2 to 24 months for the studies included in the whole network.
3) a) Number of studies included in the network: 40 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s); Number of comparison(s) informing the indirect estimate: 2 comparison(s) The range of follow up was from 1 to 12 months for the studies included in the whole network ; b) We rated down the certainty of evidence due to very serious risk of bias
4) a) We rated down the certainty of the evidence due to very serious imprecision; b) Number of studies included in the network: 11 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s); Number of comparison(s) informing the indirect estimate: 1 comparison(s). The range of follow up was from 1 to 12 months for the studies included in the whole network.
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: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: 4 comparison(s). The range of follow up was from 1 to 96 months for the studies included in the whole network.
6) 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: 29 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: 4 comparison(s). The range of follow up was from 2 to 24 months for the studies included in the whole network.
7) a) Number of studies included in the network: 43 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: comparison(s). The range of follow up was from 2 to 60 months for the studies included in the whole network. The range of follow-up was 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 imprecision and serious risk of bias
8) a) Number of studies included in the network: 30 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: 4 comparison(s). The range of follow up was from 1 to 24 months for the studies included in the whole network; b) We rated down the certainty of evidence due to serious imprecision
9) a) Number of studies included in the network: 176 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: 6 comparison(s). The range of follow up was from 1 to 96 months for the studies included in the whole network; b) We rated down the certainty of evidence due to very serious risk of bias
10) a) Number of studies included in the network: 81 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: 20 comparison(s). The range of follow up was from 1 to 36 months for the studies included in the whole network; b) We rated down the certainty of evidence due to serious imprecision
11) a) Number of studies included in the network: 145 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: 4 comparison(s). The range of follow up was from 1 to 51 months for the studies included in the whole network; b) We rated down the certainty of evidence due to serious imprecision
12) a) We rated down the certainty of evidence due to serious imprecision; b) Number of studies included in the network: 44 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: 4 comparison(s).The range of follow up was from 2 to 24 months for the studies included in the whole network.
13) a) We rated down the certainty of evidence due to very serious risk of bias and serious incoherence; b) Number of studies included in the network: 64 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=30); Number of comparison(s) informing the indirect estimate: 6 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 3 months in the studies directly comparing the self-management intervention versus usual care.
14) a) This estimate is a result of a pairwise meta-analysis (1 RCT, N=35); The range of follow-up was 24 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 imprecision
15) a) Number of studies included in the network: 55 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=30); Number of comparison(s) informing the indirect estimate: 1 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 3 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
16) a) Number of studies included in the network: 211 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=17); Number of comparison(s) informing the indirect estimate: 5 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 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 riks of bias and serious imprecision
17) 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=64); Number of comparison(s) informing the indirect estimate: 6 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 12 months in the studies directly comparing the self-management intervention versus usual care.
18) 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: 233 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=17); Number of comparison(s) informing the indirect estimate: 5 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 months in the studies directly comparing the self-management intervention versus usual care.
19) a) Number of studies included in the network: 171 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=48); Number of comparison(s) informing the indirect estimate: 7 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 12 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
20) a) We rated down the certainty of evidence due to very serious risk of bias and serious incoherence; b) Number of studies included in the network: 231 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=48); Number of comparison(s) informing the indirect estimate: 6 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 12 months in the studies directly comparing the self-management intervention versus usual care.
21) a) We rated down the certainty of evidence due to serious imprecision and serious risk of bias; b) Number of studies included in the network: 463 RCTs; Number of studies directly comparing the intervention with usual care: 3 RCT(s) (N=118); Number of comparison(s) informing the indirect estimate: 11 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 2-12 months in the studies directly comparing the self-management intervention versus usual care.
References of studies informing direct evidence:
13) Ahmadi-2018
14) Cisneros-2010
15) Ahmadi-2018
16) DeJesus-2009
17) Hornsten-2005
18) DeJesus-2009
19) Hornsten-2005
20) Hornsten-2005
21) Essien-2017, Hornsten-2005, Tavakol Moghadam-2018
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