Meta-Analysis of Biobehavioral Determinants of Health Outcomes in Type 2 Diabetes

描述（由申请人提供）：大型临床试验表明，血糖控制可改善2型糖尿病患者的健康结局，但这些患者中只有不到30%的人达到血糖目标。为了实现血糖控制，个人必须调整饮食偏好，增加体力活动，准确地坚持处方药物，并每天多次自我监测血糖水平。大量的相关性和/或预测性研究探索了可能影响行为改变和健康结果的干预变量。这些广泛的文献尚未进行系统的综述或综合。拟议的研究将：1）描述研究文献，检查心理因素，动机因素，糖尿病相关知识，健康行为和减肥结果，代谢控制和2型糖尿病生活质量之间的关联; 2）使用先前报告的研究合成的数据，测试一系列涉及这些变量的预测模型。元分析和模型测试程序将用于综合已发表和未发表的研究数据。将使用综合文献检索策略。选择的每项主要研究将涉及：a）诊断为2型糖尿病的受试者样本; B）1960年至今报告的数据; c）英语; d）体重减轻、HbA 1c、FBG和/或生活质量，作为标准变量; e）至少一项以下预测因素的指标：心理因素（压力、抑郁、焦虑）、动机因素（自我效能、授权/控制点、改变准备、健康信念）、糖尿病相关知识和/或行为因素（饮食、身体活动、药物依从性和自我监测）; f）预测变量和标准变量之间的相关矩阵形式的数据或至少一个预测变量和标准变量之间的简单相关性;和g）最少20个受试者。将采用严格的程序来建立可靠和有效的数据提取/编码。已建立的因果建模程序将用于组合研究间的联合收割机相关性，检验相关矩阵的异质性，估计研究间协方差分量矩阵，估计共同相关矩阵的随机效应，沿着预测模型路径系数的固定或随机效应估计，以及相关标准误和显著性检验。必须综合这些研究，为临床指南提供信息，以便临床医生能够有效地应对日益增长的全球糖尿病流行。 公共卫生相关性：尽管最近的技术和药物进步，只有不到百分之三十的人诊断为2型糖尿病实现血糖目标。为了实现血糖控制，个体必须适应饮食偏好，增加身体活动，准确地坚持处方药物，并且每天多次自我监测葡萄糖水平。这项拟议的研究涉及对糖尿病干预中需要强调的心理、动机和行为因素进行的大量研究的系统综合，以改善糖尿病健康结果，特别是与血糖控制和生活质量相关的因素。所获得的信息将为临床指南提供信息，以便临床医生能够有效地应对日益增长的全球糖尿病流行病。

DESCRIPTION (provided by applicant): Large clinical trials demonstrated that glycemic control improves health outcomes in persons with type 2 diabetes, but fewer than 30% of these individuals achieve glycemic goals. To achieve glycemic control, individuals must adapt dietary preferences, increase physical activity, accurately adhere to prescribed medications, and self-monitor glucose levels several times per day. A large body of correlational and/or predictive research has explored intervening variables that may affect behavior change and health outcomes. This extensive literature has not been systematically reviewed nor synthesized. The proposed study will: 1) describe the research literature that examines associations among psychological factors, motivational factors, diabetes-related knowledge, and health behaviors and outcomes of weight loss, metabolic control, and quality of life in type 2 diabetes; and 2) using data synthesized from previously reported studies, test a series of predictive models that involve these variables. Meta-analytic and model- testing procedures will be used to synthesize both published and unpublished research data. Comprehensive literature search strategies will be used. Each primary study selected will involve: a) a sample of subjects diagnosed with type 2 diabetes; b) data reported between 1960 and the present; c) English language; d) weight loss, HbA1c, FBG, and/or quality of life measured as the criterion variable(s); e) a measure of at least one of the following predictors: psychological factors (stress, depression, anxiety), motivational factors (self-efficacy, empowerment/locus of control, readiness for change, health beliefs), diabetes-related knowledge, and/or behavioral factors (diet, physical activity, medication adherence, and self-monitoring); f) data in the form of correlation matrices among predictor and criterion variables or a simple correlation between at least one predictor and a criterion variable; and g) a minimum of 20 subjects. Rigorous procedures for establishing reliable and valid data extraction/coding will be employed. Established causal modeling procedures will be used to combine correlations across studies, test for heterogeneity of the correlation matrices, estimate the between-studies covariance components matrix, and estimate the random-effects of the common correlation matrix, along with either fixed- or random-effects estimation of the path coefficients of the predictive model, and the associated standard errors and significance tests. It is imperative to synthesize these studies to inform clinical guidelines so that clinicians can effectively address the growing global diabetes epidemic. PUBLIC HEALTH RELEVANCE: Despite recent technological and pharmaceutical advancements, fewer than thirty percent of individuals diagnosed with type 2 diabetes achieve glycemic goals. To achieve glycemic control, individuals must adapt dietary preferences, increase physical activity, accurately adhere to prescribed medications, and self- monitor glucose levels several times per day. The proposed study involves a systematic synthesis of the large body of research conducted on the psychological, motivational, and behavioral factors that need to be emphasized in diabetes interventions in order to improve diabetes health outcomes, particularly those related to glycemic control and quality of life. The information obtained will inform clinical guidelines so that clinicians can effectively address the growing global diabetes epidemic.