Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes
Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes
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DOI：
10.1016/s0140-6736(04)16202-8
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发表时间：
2004-05-15
期刊：
影响因子：
168.9
通讯作者：
Rabe-Hesketh, S
中科院分区：
文献类型：
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作者：
Ismail, K;Winkley, K;Rabe-Hesketh, S
背景糖尿病患者的血糖控制不良与依从性困难和心理问题有关。我们进行了系统的回顾和荟萃分析的心理治疗，以评估其有效性，提高血糖控制在2型diabetes.Methods，我们搜索MEDLINE，PsychINFO，EMBASE，和科克伦中央注册对照试验到2003年1月。符合条件的研究是随机对照试验，涉及2型糖尿病患者，并评估心理治疗（咨询，认知行为治疗或心理动力学治疗），以改善糖尿病控制。我们提取了参与者的数量，他们的年龄，糖尿病的持续时间，血糖控制，心理治疗的类型，其交付方式，以及对照组的干预类型。主要结果是通过糖化血红蛋白百分比测量的长期贫血控制。血糖浓度，体重和心理困扰也进行了测量。计算了合并的标准化效应量。结果25项试验符合审查资格。在12项试验中，分配到心理干预组的人的平均糖化血红蛋白百分比低于对照组（常规护理，教育，等候名单或注意力控制）;汇总平均差异为-0.32（95%CI-0.57至-0.07），相当于-0.76%的绝对差异。血糖浓度（8项试验; -0.11 [-0.65至0.42]）和体重增加（9项试验; 0.37 [-0.18至0.93]）无显著差异。心理困扰在干预组中显著降低（5个试验; -0.58 [-0.95 to -0.20]）。解释在2型糖尿病中，接受心理治疗的人在长期血糖控制和心理困扰方面有改善，但在体重控制或血糖浓度方面没有改善。
Background Adherence difficulties and psychological problems are associated with poor glycaemic control in diabetes. We undertook a systematic review and meta-analysis of psychological therapies to assess their effectiveness in improving glycaemic control in type 2 diabetes.Methods We searched MEDLINE, PsychINFO, EMBASE, and the Cochrane Central Register of Controlled Trials up to January, 2003. Eligible studies were randomised controlled trials that involved people with type 2 diabetes and evaluated a psychological therapy (counselling, cognitive behaviour therapy, or psychodynamic therapy) to improve diabetes control. We extracted the number of participants, their age, duration of diabetes, glycaemic control, type of psychological therapy, its mode of delivery, and type of intervention in the control group. The main outcome was long-term glycaemic control measured by percentage of glycated haemoglobin. Blood glucose concentration, weight, and psychological distress were also measured. Pooled standardised effect sizes were calculated.Findings 25 trials were eligible for the review. In 12 trials, the mean percentage glycated haemoglobin was lower in people assigned a psychological intervention than in the control group (usual care, education, waiting list, or attention control); the pooled mean difference was -0.32 (95% CI -0.57 to -0.07) equivalent to an absolute difference of -0.76%. There were non-significant differences in blood glucose concentration (eight trials; -0.11 [-0.65 to 0.42]) and weight gain (nine trials; 0.37 [-0.18 to 0.93]). Psychological distress was significantly lower in the intervention groups (five trials; -0.58 [-0.95 to -0.20]).Interpretation In type 2 diabetes, there are improvements in long-term glycaemic control and psychological distress but not in weight control or blood glucose concentration in people who receive psychological therapies.