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

2 型糖尿病健康结果的生物行为决定因素的荟萃分析

• 批准号: 8305982
• 负责人: SHARON A BROWN
• 金额: $ 33.05万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-29 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8305982
• 关键词: Address; Adverse effects; Affect; Age; American; Anxiety; Behavioral; Body Weight decreased; Boxing; Caring; Cessation of life; Characteristics; Chronic Disease; Clinical; Clinical Trials; Code; Comorbidity; Complications of Diabetes Mellitus; Control Locus; Coupled; Data; Data Reporting; Decision Making; Diabetes Mellitus; Diagnosis; Diet; Dietary intake; Disease; Dose; Economics; Education; Educational Status; Effectiveness; English Language; Epidemic; Failure; Fostering; Future; Gender; Generations; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Guidelines; Habits; Health; Health Care Costs; Health Professional; Health behavior; Health behavior change; Health behavior outcomes; Heterogeneity; Home environment; Hypertension; Individual; Insulin; Insulin-Dependent Diabetes Mellitus; International; Intervention; Kidney Failure; Knowledge; Label; Life; Life Style; Literature; Measurement; Measures; Mediating; Mediator of activation protein; Medical; Mental Depression; Meta-Analysis; Metabolic Control; Methods; Modeling; Monitor; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Patients; Persons; Pharmaceutical Preparations; Pharmacologic Substance; Physical activity; Physiological; Play; Population; Prevalence; Procedures; Productivity; Psychological Factors; Publishing; Quality of life; Readiness; Reporting; Research; Research Design; Research Personnel; Risk; Role; Sample Size; Sampling; Self Care; Self Efficacy; Self Management; Series; Social support; Stress; Testing; Time; Treatment Protocols; biobehavior; blood glucose regulation; contextual factors; diabetes control; diabetes management; disability; dosage; empowerment; evidence base; glucose monitor; glycemic control; health belief; improved; innovation; instrument; medication compliance; member; non-compliance; novel; predictive modeling; preference; premature; prevent; prospective; psychologic; public health relevance; racial and ethnic; recidivism; sedentary; self medication (prescribed); text searching

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.

描述（由申请人提供）：大型临床试验表明，血糖控制可以改善 2 型糖尿病患者的健康状况，但这些患者中只有不到 30% 能够达到血糖目标。为了实现血糖控制，个人必须调整饮食偏好，增加体力活动，准确遵守处方药物，并每天多次自我监测血糖水平。大量相关和/或预测研究已经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经过系统回顾或综合。拟议的研究将：1）描述研究文献，检查2型糖尿病患者的心理因素、动机因素、糖尿病相关知识以及健康行为和减肥结果、代谢控制和生活质量之间的关联； 2）使用先前报告的研究合成的数据，测试涉及这些变量的一系列预测模型。荟萃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) 诊断患有 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) 作为标准变量测量的体重减轻、HbA1c、FBG 和/或生活质量； e) 至少衡量以下预测因素之一：心理因素（压力、抑郁、焦虑）、动机因素（自我效能、赋权/控制点、改变准备程度、健康信念）、糖尿病相关知识和/或行为因素（饮食、体力活动、药物依从性和自我监控）； f) 预测变量和标准变量之间的相关矩阵或至少一个预测变量和标准变量之间的简单相关性形式的数据； g) 至少 20 名受试者。将采用严格的程序来建立可靠且有效的数据提取/编码。已建立的因果建模程序将用于组合研究之间的相关性，测试相关矩阵的异质性，估计研究间协方差分量矩阵，并估计公共相关矩阵的随机效应，以及预测模型路径系数的固定或随机效应估计，以及相关的标准误差和显着性检验。必须综合这些研究来为临床指南提供信息，以便临床医生能够有效应对全球日益严重的糖尿病流行问题。 公共健康相关性：尽管最近技术和制药取得了进步，但诊断出的 2 型糖尿病患者中只有不到 30% 能够达到血糖目标。为了实现血糖控制，个人必须调整饮食偏好，增加体力活动，准确遵守处方药物，并每天多次自我监测血糖水平。拟议的研究系统地综合了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，以改善糖尿病的健康结果，特别是与血糖控制和生活质量相关的结果。获得的信息将为临床指南提供依据，以便临床医生能够有效应对全球日益严重的糖尿病流行问题。

项目成果

Biobehavioral determinants of glycemic control in type 2 diabetes: A systematic review and meta-analysis.

• DOI: 10.1016/j.pec.2016.03.020
• 发表时间: 2016-10
• 期刊: Patient education and counseling
• 影响因子: 3.5
• 作者: Brown SA;García AA;Brown A;Becker BJ;Conn VS;Ramírez G;Winter MA;Sumlin LL;Garcia TJ;Cuevas HE
• 通讯作者: Cuevas HE

Model-driven meta-analyses for informing health care: a diabetes meta-analysis as an exemplar.

• DOI: 10.1177/0193945914548229
• 发表时间: 2015-04
• 期刊: Western journal of nursing research
• 影响因子: 1.8
• 作者: Brown SA;Becker BJ;García AA;Brown A;Ramírez G
• 通讯作者: Ramírez G

Depression and adherence to lifestyle changes in type 2 diabetes: a systematic review.

• DOI: 10.1177/0145721714538925
• 发表时间: 2014-11
• 期刊: The Diabetes educator
• 作者: Sumlin LL;Garcia TJ;Brown SA;Winter MA;García AA;Brown A;Cuevas HE
• 通讯作者: Cuevas HE