Effectiveness of health coaching on diabetic patients: A systematic review and meta-analysis

Abstract

Background: Using health coaching to improve the quality of life and health outcomes of the patients with diabetes mellitus, has emerged as a possible intervention. However, the few published randomized controlled trials using health coaching for patients with diabetes mellitus have reported mixed results. The present meta-analysis aimed to determine the effectiveness of health coaching on modifying health status and quality of life among diabetic patients and to clarify the characteristics of coaching delivery that make it most effective. Methods: This study searched for articles on randomized controlled trials of health coaching interventions targeting type 2 diabetic patients that were published in the English language from January 2005 through December 2018 in the Cochrane, Medline, PubMed, Trip, and Embase databases. Patients in the control group received usual diabetes mellitus care, and those in the experimental group received health coaching based on usual diabetes mellitus care. The primary outcomes included Hemoglobin A1c (HbA1c) and cardiovascular disease risk factors, including systolic blood pressure, diastolic blood pressure, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, total cholesterol, and body weight. The secondary outcomes included quality of life, self-efficacy, self-care skills, and psychological outcomes. Results: Health coaching intervention has a significant effect on HbA1c [mean difference (MD) = -0.35, confidence interval (CI) = -0.47, -0.22, I2 = 83%, P < 0.001] and HDL-C (MD = -0.50, CI = -0.93, -0.07, I2 = 10%, P = 0.02). The most effective strategy for health coaching delivery associated with improvement of HbA1c was decreasing the number of sessions and increasing the duration of each session. However, no significant difference was found for weight, SBP, diastolic blood pressure, triglyceride, low-density lipoprotein cholesterol, or total cholesterol. Mixed results were reported for the effect of health coaching on quality of life, self-efficacy, self-care skills, and depressive symptoms outcome. Conclusion: Health coaching intervention has a significant effect on HbA1c and HDL-C, and the most effective strategy is decreasing the number of sessions while increasing session duration. However, these results should be interpreted with caution as the evidence comes from studies at some risk of bias with considerable heterogeneity and imprecision.