Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis.
Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis.
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DOI：
10.1186/1472-6963-12-213
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发表时间：
2012-07-23
影响因子：
2.8
通讯作者：
Fretheim A
中科院分区：
文献类型：
--
作者：
Steinsbekk A;Rygg LØ;Lisulo M;Rise MB;Fretheim A
糖尿病自我管理教育(DSME)可以通过多种形式提供。基于小组的DSME由于是一种成本较低的方法以及患者之间可以见面和讨论的额外优势而得到广泛应用。评估基于群体的DSME与常规治疗对2型糖尿病患者的临床、生活方式和心理社会结局的影响。运用Meta分析进行系统综述。检索截至2008年1月的计算机化文献数据库，以寻找随机对照试验，评估基于组的DSME对成人2型糖尿病患者与常规治疗的对照，其中干预至少进行一次疗程，并进行6个 月的随访。至少有两名评价者独立提取数据并评估研究质量。共纳入21项研究(26篇出版物，2833名参与者)。在所有参与者中，男性占4/10，基线年龄为60 岁，体重指数为31.6，糖化血红蛋白为8.23%，糖尿病病程为8 年，82%使用药物。在主要临床结果方面，HbA1c在6个 月(0.44%分；P = 0.0006，13项研究，1,883名参与者)、12个 月(0.46%分；P = 0.001，11项研究，1,503名参与者)和2个 年(0.87%分；P <； 0.00001，3项研究，397名参与者)显著降低；空腹血糖水平在12个 月(1.26mmol/L；P <； 0.00001，5项研究，690名参与者)也显著降低，但在6个 月时未见显著下降。在主要生活方式结果方面，糖尿病知识在6个 月(SMD0.83；P = 0.00001，6项研究，768名参与者)、12个 月(SMD0.85；P <； 0.00001，5项研究，955名参与者)和2个 年(SMD1.59；P = 0.03，2项研究，355名参与者)时显著改善，自我管理技能在6个 月(SMD0.55；P = 0.01，4项研究，534名参与者)也显著提高。在主要心理社会结果方面，赋权/自我效能在6个 = 月后有显著改善(SMD0.28，P 0.01，2项研究，326名参与者)。对于生活质量，由于高度的异质性，无法得出结论。对于次要结果，干预组在12个 月时患者满意度和体重有显著改善。在死亡率、体重指数、血压和血脂方面，两组之间没有差异。在2型糖尿病患者中，基于群体的DSME可以改善临床、生活方式和心理社会结果。
Diabetes self-management education (DSME) can be delivered in many forms. Group based DSME is widespread due to being a cheaper method and the added advantages of having patient meet and discuss with each other. assess effects of group-based DSME compared to routine treatment on clinical, lifestyle and psychosocial outcomes in type-2 diabetes patients. A systematic review with meta-analysis. Computerised bibliographic database were searched up to January 2008 for randomised controlled trials evaluating group-based DSME for adult type-2 diabetics versus routine treatment where the intervention had at least one session and =/>6 months follow-up. At least two reviewers independently extracted data and assessed study quality. In total 21 studies (26 publications, 2833 participants) were included. Of all the participants 4 out of 10 were male, baseline age was 60 years, BMI 31.6, HbA1c 8.23%, diabetes duration 8 years and 82% used medication. For the main clinical outcomes, HbA1c was significantly reduced at 6 months (0.44% points; P = 0.0006, 13 studies, 1883 participants), 12 months (0.46% points; P = 0.001, 11 studies, 1503 participants) and 2 years (0.87% points; P < 0.00001, 3 studies, 397 participants) and fasting blood glucose levels were also significantly reduced at 12 months (1.26 mmol/l; P < 0.00001, 5 studies, 690 participants) but not at 6 months. For the main lifestyle outcomes, diabetes knowledge was improved significantly at 6 months (SMD 0.83; P = 0.00001, 6 studies, 768 participants), 12 months (SMD 0.85; P < 0.00001, 5 studies, 955 participants) and 2 years (SMD 1.59; P = 0.03, 2 studies, 355 participants) and self-management skills also improved significantly at 6 months (SMD 0.55; P = 0.01, 4 studies, 534 participants). For the main psychosocial outcomes, there were significant improvement for empowerment/self-efficacy (SMD 0.28, P = 0.01, 2 studies, 326 participants) after 6 months. For quality of life no conclusion could be drawn due to high heterogeneity. For the secondary outcomes there were significant improvements in patient satisfaction and body weight at 12 months for the intervention group. There were no differences between the groups in mortality rate, body mass index, blood pressure and lipid profile. Group-based DSME in people with type 2 diabetes results in improvements in clinical, lifestyle and psychosocial outcomes.