PMID- 31932394 OWN - NLM STAT- MEDLINE DCOM- 20210209 LR - 20230829 IS - 2044-6055 (Electronic) IS - 2044-6055 (Linking) VI - 10 IP - 1 DP - 2020 Jan 12 TI - Effectiveness of non-pharmacological strategies in the management of type 2 diabetes in primary care: a protocol for a systematic review and network meta-analysis. PG - e034481 LID - 10.1136/bmjopen-2019-034481 [doi] LID - e034481 AB - INTRODUCTION: Despite the increasing number of drugs and various guidelines on the management of type 2 diabetes mellitus (T2DM), several patients continue with the disease uncontrolled. There are several non-pharmacological treatments available for managing T2DM, but various of them have never been compared directly to determine the best strategies. OBJECTIVE: This study will evaluate the comparative effects of non-pharmacological strategies in the management of T2DM in primary care or community settings. METHODS AND ANALYSIS: We will perform a systematic review and network meta-analysis (NMA), and will include randomised controlled trials if one of the following interventions were applied in adult patients with T2DM: nutritional therapy, physical activity, psychological interventions, social interventions, multidisciplinary lifestyle interventions, diabetes self-management education and support (DSMES), technology-enabled DSMES, interventions delivered only either by pharmacists or by nurses, self-blood glucose monitoring in non-insulin-treated T2DM, health coaching, benchmarking and usual care. The primary outcome will be glycaemic control (glycated haemoglobin (HbA1c) (%)), and the secondary outcomes will be weight loss, quality of life, patient satisfaction, frequency of cardiovascular events and deaths, number of patients in each group with HbA1c <7, adverse events and medication adherence. We have developed search strategies for Embase, Medline, Latin American and Caribbean Health Sciences Literature, Cochrane Central Register of Controlled Trials, Trip database, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature Australasian Medical Index and Chinese Biomedical Literature Database. Four reviewers will assess the studies for their eligibility and their risk of bias in pairs and independently. An NMA will be performed using a Bayesian hierarchical model, and the treatment hierarchy will be obtained using the surface under the cumulative ranking curve. To determine our confidence in an overall treatment ranking from the NMA, we will follow the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION: As no primary data collection will be undertaken, no formal ethical assessment is required. We plan to present the results of this systematic review in a peer-reviewed scientific journal, conferences and the popular press. PROSPERO REGISTRATION NUMBER: CRD42019127856. CI - (c) Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Leite, Renata Giacomini Oliveira Ferreira AU - Leite RGOF AD - Department of Internal Medicine, Sao Paulo State University/UNESP, Medical School, Botucatu, Sao Paulo, Brazil. FAU - Banzato, Luisa Rocco AU - Banzato LR AD - Department of Internal Medicine, Sao Paulo State University/UNESP, Medical School, Botucatu, Sao Paulo, Brazil. FAU - Galendi, Julia Simoes Correa AU - Galendi JSC AD - Department of Internal Medicine, Sao Paulo State University/UNESP, Medical School, Botucatu, Sao Paulo, Brazil. FAU - Mendes, Adriana Lucia AU - Mendes AL AD - Department of Internal Medicine, Sao Paulo State University/UNESP, Medical School, Botucatu, Sao Paulo, Brazil. FAU - Bolfi, Fernanda AU - Bolfi F AD - Department of Internal Medicine, Sao Paulo State University/UNESP, Medical School, Botucatu, Sao Paulo, Brazil. FAU - Veroniki, Areti Angeliki AU - Veroniki AA AUID- ORCID: 0000-0001-6388-4825 AD - Department of Primary Education, School of Education, University of Ioannina, loannina, Greece. AD - Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. AD - Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom. FAU - Thabane, Lehana AU - Thabane L AD - Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. AD - Departments of Pediatrics and Anesthesia, McMaster University, Hamilton, ON, Canada. FAU - Nunes-Nogueira, Vania Dos Santos AU - Nunes-Nogueira VDS AUID- ORCID: 0000-0001-9316-4167 AD - Department of Internal Medicine, Sao Paulo State University/UNESP, Medical School, Botucatu, Sao Paulo, Brazil vania.nunes-nogueira@unesp.br. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200112 PL - England TA - BMJ Open JT - BMJ open JID - 101552874 SB - IM MH - Diabetes Mellitus, Type 2/*therapy MH - *Disease Management MH - Humans MH - *Medication Adherence MH - Network Meta-Analysis MH - Primary Health Care/*methods MH - Systematic Reviews as Topic PMC - PMC7045081 OTO - NOTNLM OT - diabetes mellitus type 2 OT - network meta-analysis OT - primary health care OT - systematic review COIS- Competing interests: None declared. EDAT- 2020/01/15 06:00 MHDA- 2021/02/10 06:00 PMCR- 2020/01/12 CRDT- 2020/01/15 06:00 PHST- 2020/01/15 06:00 [entrez] PHST- 2020/01/15 06:00 [pubmed] PHST- 2021/02/10 06:00 [medline] PHST- 2020/01/12 00:00 [pmc-release] AID - bmjopen-2019-034481 [pii] AID - 10.1136/bmjopen-2019-034481 [doi] PST - epublish SO - BMJ Open. 2020 Jan 12;10(1):e034481. doi: 10.1136/bmjopen-2019-034481.