Reducing Risks in Diabetes Self-management

A Systematic Review of the Literature

Suzanne Austin Boren, PhD, MHA, Teira L. Gunlock, MHA, Judith Schaefer, MPH and Ann Albright, PhD, RD

From the Health Services Research & Development Program, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri, and the Center for Health Care Quality (Dr Boren); Department of Health Management & Informatics, School of Medicine, University of Missouri, Columbia (Dr Boren, Ms Gunlock); Center for Health Care Quality, School of Medicine, University of Missouri, Columbia (Ms Gunlock); Center for Health Studies, Group Health Cooperative, Seattle, Washington (Ms Schaefer); and Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Albright).

Correspondence to Suzanne Austin Boren, PhD, MHA, Health Services Research and Development, Harry S. Truman Memorial Veterans Hospital, 800 Hospital Drive, Columbia, MO 65201 (


The purpose of this systematic review was to review published literature on risk-reducing interventions as part of diabetes self-management.

Data Sources

Medline (1990-2007), CINAHL (1990-2007), and Cochrane Central Register of Controlled Trials (first quarter 2007) databases were searched. Reference lists from included studies were reviewed to identify additional studies.

Study Selection

Intervention studies that addressed reducing risks to help prevent or minimize diabetes complications were included.

Data Extraction

Study design, sample characteristics, interventions, and outcomes were extracted.

Data Synthesis

Thirty-three studies, represented by 39 articles, met the criteria for inclusion and were classified as smoking cessation (n = 3), eye examination (n = 2), foot care (n = 10), oral health (n = 2), vaccination (n = 1), cardiovascular risk reduction (n = 9), and comprehensive risk reduction (n = 6). Only 46.3% of the 283 outcomes measured in the 33 studies were significantly improved.


Reducing risks involves implementing effective risk reduction behaviors to prevent or slow the progression of diabetes complications. Recognizing risk factors for complications and what constitutes optimal preventive care is an important part of managing diabetes. Intervention studies are lacking in some areas of reducing risks. Further studies are needed to test specific interventions to reduce the risks of diabetes complications.

Link to full-text version of the review in The Diabetes Educator journal