Norris S L, Engelgau M M, Narayan K M
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Diabetes Care. 2001 Mar;24(3):561-87. doi: 10.2337/diacare.24.3.561.
To systematically review the effectiveness of self-management training in type 2 diabetes.
MEDLINE, Educational Resources Information Center (ERIC), and Nursing and Allied Health databases were searched for English-language articles published between 1980 and 1999. Studies were original articles reporting the results of randomized controlled trials of the effectiveness of self-management training in people with type 2 diabetes. Relevant data on study design, population demographics, interventions, outcomes, methodological quality, and external validity were tabulated. Interventions were categorized based on educational focus (information, lifestyle behaviors, mechanical skills, and coping skills), and outcomes were classified as knowledge, attitudes, and self-care skills; lifestyle behaviors, psychological outcomes, and quality of life; glycemic control; cardiovascular disease risk factors; and economic measures and health service utilization.
A total of 72 studies described in 84 articles were identified for this review. Positive effects of self-management training on knowledge, frequency and accuracy of self-monitoring of blood glucose, self-reported dietary habits, and glycemic control were demonstrated in studies with short follow-up (<6 months). Effects of interventions on lipids, physical activity, weight, and blood pressure were variable. With longer follow-up, interventions that used regular reinforcement throughout follow-up were sometimes effective in improving glycemic control. Educational interventions that involved patient collaboration may be more effective than didactic interventions in improving glycemic control, weight, and lipid profiles. No studies demonstrated the effectiveness of self-management training on cardiovascular disease-related events or mortality; no economic analyses included indirect costs; few studies examined health-care utilization. Performance, selection, attrition, and detection bias were common in studies reviewed, and external generalizability was often limited.
Evidence supports the effectiveness of self-management training in type 2 diabetes, particularly in the short term. Further research is needed to assess the effectiveness of self-management interventions on sustained glycemic control, cardiovascular disease risk factors, and ultimately, microvascular and cardiovascular disease and quality of life.
系统评价自我管理培训对2型糖尿病的有效性。
检索MEDLINE、教育资源信息中心（ERIC）以及护理与相关健康数据库，查找1980年至1999年间发表的英文文章。研究为原创文章，报告了2型糖尿病患者自我管理培训有效性的随机对照试验结果。将关于研究设计、人群统计学、干预措施、结局、方法学质量和外部效度的相关数据制成表格。干预措施根据教育重点（信息、生活方式行为、操作技能和应对技能）进行分类，结局分为知识、态度和自我护理技能；生活方式行为、心理结局和生活质量；血糖控制；心血管疾病危险因素；以及经济指标和卫生服务利用情况。
本综述共纳入84篇文章中描述的72项研究。在随访时间较短（<6个月）的研究中，自我管理培训对知识、血糖自我监测的频率和准确性、自我报告的饮食习惯以及血糖控制产生了积极影响。干预措施对血脂、身体活动、体重和血压的影响各不相同。随访时间延长后，在整个随访过程中进行定期强化的干预措施有时在改善血糖控制方面有效。涉及患者协作的教育干预措施在改善血糖控制、体重和血脂谱方面可能比单纯讲授式干预措施更有效。没有研究证明自我管理培训对心血管疾病相关事件或死亡率有效；没有经济分析纳入间接成本；很少有研究考察卫生保健利用情况。在所审查的研究中，表现、选择、损耗和检测偏倚很常见，外部可推广性往往有限。
有证据支持自我管理培训对2型糖尿病有效，尤其是在短期内。需要进一步研究以评估自我管理干预措施对持续血糖控制、心血管疾病危险因素以及最终对微血管和心血管疾病及生活质量的有效性。
