Long-term effects of non-pharmacological interventions in adolescents and young adults with type 1 diabetes: A systematic review and meta-analysis.

The trials varied widely in intervention content, duration, frequency, and format, so the pooled result cannot be translated into one specific programme. Heterogeneity was high for the six-month HbA1c effect, meaning the included studies did not agree closely. Many trials had some concerns about risk of bias, especially allocation concealment, missing data, and outcome measurement because participants and staff could not be blinded. Most trials were small, and only a few studies followed participants beyond twelve months, limiting confidence in long-term effects. The studies were mostly from North America and Europe and involved mainly White and African American participants, so results may not apply to other regions or ethnic groups. Cardiovascular risk factors, a key complication outcome, were not analysed because too few studies reported them. Many effective programmes combined several components, such as self-care behaviour management, education, and psychological support, so the study cannot identify which component produced the effects.

The study was funded by the National Research Foundation of Korea through the Ministry of Education. The authors declared no conflicts of interest.

Do not read the six-month HbA1c improvement as lasting glycaemic control. The pooled effect was not significant at seven to twelve months or beyond twelve months.