Six studies [19], [32], [33], [35], [38] and [42] reported on dietary

outcomes; two [33] and [38] had positive effects. Z-VAD-FMK solubility dmso Thirty-six intervention features were included in the analysis, of which 11 were associated with a positive rate difference (see Table 2). Refer to the online supplemental data for more information on percent success rate differences (Table 3) and analysis of features within each individual outcome (Tables 4–7). DSME programs are complex interventions with various content and delivery components necessary for the education and skills building required for diabetes self-management. However, limited efforts have been made to investigate which intervention features are associated with a positive outcome, specifically for women of diverse ethnic backgrounds. Studies mainly concentrated on glycemic control (i.e., HbA1c levels) (10 studies) or anthropometric outcomes (11 studies), as opposed to behavioral outcomes such as diet (5 studies) and physical Thiazovivin activity (5 studies). Since

behavioral outcomes strongly reflect the lifestyle changes needed to achieve the desirable metabolic outcomes [18] and [44], it is imperative to understand how intervention features affect these intermediary outcomes as well. Only five (of 38) intervention features had positive success rate differences for at least three of the outcomes examined in this review: hospital-based intervention setting; group intervention format; situational problem-solving; high intensity (10 or more intervention sessions); and incorporating dietitians as interventionists. Because of their broad influence, we recommend the features

that demonstrate success across multiple outcomes in DSME programming for the populations of interest. Many of these features are also recommended in DSME programming for the general population by the American Diabetes Association (ADA) and the Canadian Diabetes Association (CDA). Specifically, group programming and situational old problem-solving are recommended by both national organizations [45] and [45], as these features are shown to be effective in improving HbA1c outcomes [46]. Furthermore, the CDA recommends nutritional counseling of clients with diabetes by a dietitian, either one-on-one or in small group settings, to lower HbA1c levels [45]. A recent study supports this recommendation; it found that visits by a dietitian are associated with lower hospitalization rates and charges in persons of varied cultural backgrounds compared to diabetes classes and one-on-one visits from non-dietitian health professionals [47]. Our analysis suggests that incorporating dietitians has positive success rate differences on anthropometrics, and physical activity, in addition to HbA1c. We are unsure why hospital-based interventions appear more successful across outcomes.