Norris Susan L, Lau Joseph, Smith S Jay, Schmid Christopher H, Engelgau Michael M
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Diabetes Care. 2002 Jul;25(7):1159-71. doi: 10.2337/diacare.25.7.1159.
To evaluate the efficacy of self-management education on GHb in adults with type 2 diabetes.
We searched for English language trials in Medline (1980-1999), Cinahl (1982-1999), and the Educational Resources Information Center database (ERIC) (1980-1999), and we manually searched review articles, journals with highest topic relevance, and reference lists of included articles. Studies were included if they were randomized controlled trials that were published in the English language, tested the effect of self-management education on adults with type 2 diabetes, and reported extractable data on the effect of treatment on GHb. A total of 31 studies of 463 initially identified articles met selection criteria. We computed net change in GHb, stratified by follow-up interval, tested for trial heterogeneity, and calculated pooled effects sizes using random effects models. We examined the effect of baseline GHb, follow-up interval, and intervention characteristics on GHb.
On average, the intervention decreased GHb by 0.76% (95% CI 0.34-1.18) more than the control group at immediate follow-up; by 0.26% (0.21% increase - 0.73% decrease) at 1-3 months of follow-up; and by 0.26% (0.05-0.48) at > or = 4 months of follow-up. GHb decreased more with additional contact time between participant and educator; a decrease of 1% was noted for every additional 23.6 h (13.3-105.4) of contact.
Self-management education improves GHb levels at immediate follow-up, and increased contact time increases the effect. The benefit declines 1-3 months after the intervention ceases, however, suggesting that learned behaviors change over time. Further research is needed to develop interventions effective in maintaining long-term glycemic control.
评估自我管理教育对2型糖尿病成年患者糖化血红蛋白（GHb）的疗效。
我们在医学文献数据库（Medline，1980 - 1999年）、护理学与健康领域数据库（Cinahl，1982 - 1999年）以及教育资源信息中心数据库（ERIC，1980 - 1999年）中检索英文试验，并人工检索综述文章、主题相关性最高的期刊以及纳入文章的参考文献列表。纳入的研究需为以英文发表的随机对照试验，测试自我管理教育对2型糖尿病成年患者的效果，并报告关于治疗对GHb影响的可提取数据。在最初识别的463篇文章中，共有31项研究符合入选标准。我们计算了按随访间隔分层的GHb净变化，测试试验异质性，并使用随机效应模型计算合并效应量。我们研究了基线GHb、随访间隔和干预特征对GHb的影响。
在即刻随访时，干预组平均使GHb降低的幅度比对照组多0.76%（95%置信区间0.34 - 1.18）；在随访1 - 3个月时降低0.26%（增加0.21% - 降低0.73%）；在随访≥4个月时降低0.26%（0.05 - 0.48）。随着参与者与教育者之间接触时间的增加，GHb降低得更多；每增加23.6小时（13.3 - 105.4）的接触，GHb降低1%。
自我管理教育在即刻随访时可改善GHb水平，且增加接触时间会增强效果。然而，干预停止1 - 3个月后益处下降，这表明习得行为会随时间改变。需要进一步研究以开发有效维持长期血糖控制的干预措施。
