Meta-analysis of the effect of self-management behavior intervention measures in older adults with coronary heart disease and diabetes mellitus.

BACKGROUND

With population aging, the prevalence of older adults with coronary heart disease (CHD) and diabetes mellitus (DM) is increasing. These patients face complex disease burdens, and self-management behaviors are crucial for disease control and prognosis. However, current interventions show inconsistent results. This meta-analysis systematically evaluates the effects of self-management behavior interventions in older adults with CHD and DM.

METHODS

PubMed, Web of Science, and Embase were searched from inception to February 2025 for randomized controlled trials on self-management behavior interventions in older adults with CHD and DM. Two researchers independently screened studies, extracted data, and assessed bias risk. Nine studies involving 1757 patients were included. The primary outcome was the self-management behavior score; secondary outcomes were HbA1c, fasting plasma glucose (FPG), total cholesterol (TC), and cardiovascular adverse event incidence. Meta-regression and sensitivity analyses (leave-one-out method) were conducted to explore sources of heterogeneity. The GRADE approach was used to assess evidence certainty.

RESULTS

Compared with conventional care, comprehensive self-management behavior interventions significantly improved self-management scores [SMD = 1.32, 95% CI (1.10-1.54), P < 0.05]. Biochemical markers significantly improved in intervention groups: HbA1c [SMD = -0.91, 95% CI (-1.10 to -0.72)], FPG [SMD = -0.87, 95% CI (-1.06 to -0.68)], and TC [SMD = -0.80, 95% CI (-0.98 to -0.62)], all P < 0.05. Cardiovascular adverse event incidence was significantly lower in intervention groups [RR = 1.77, 95% CI (1.73-1.82), P < 0.05]. Substantial statistical heterogeneity was observed for the primary outcome (I 2 = 79.2%). Meta-regression identified intervention type (digital vs. non-digital) as a significant moderator [coefficient = 0.52, 95% CI (0.18-0.86), P = 0.008], explaining 34.2% of between-study variance. Sensitivity analysis confirmed that no single study drove the pooled effect, supporting the robustness of the result.

CONCLUSION

Comprehensive self-management behavior interventions effectively enhance self-management levels, improve glucose and lipid metabolism, and reduce cardiovascular events in older adults with CHD and DM. However, the substantial heterogeneity (I 2 = 79.2%) indicates that pooled effect sizes should be interpreted with caution; intervention type (digital vs. non-digital) is a significant contributor to heterogeneity. Future high-quality RCTs with standardized outcome measures are needed to refine these estimates.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42025271896.