Behavioral Medicine Research, Baystate Medical Center, Springfield, MA 01199, USA.
Diabetes Res Clin Pract. 2010 Apr;88(1):1-6. doi: 10.1016/j.diabres.2009.12.026. Epub 2010 Feb 8.
We conducted a meta-analysis of studies reporting diabetes case management interventions to examine the impact of case management on blood glucose control (HbA1c). Databases used for the search included Medline, PubMed, Cochrane EPOC, Cumulative Index to Nursing & Allied Health Literature database guide (CINAHL), and PsychInfo. A composite estimate of effect size was calculated using a random effects model and subgroup analyses were conducted. Twenty-nine salient studies involving 9397 patients had sufficient data for analysis. Mean patient age was 63.2 years, 49% were male, and ethnicity/race was 54% White. Type 2 diabetes was the focus in 91% of studies. Results showed a large overall effect size favoring case management intervention over controls or baseline values on HbA1c (ES=0.86, 95%CI: 0.52-1.19, Z=5.0, p<0.001). This corresponds to a mean HbA1c reduction of 0.89 (95%CI: 0.63-1.15). Subgroup analyses showed clinical setting, team composition, and baseline HbA1c were important predictors of effect size, but not diabetes self-management education which was poorly described or absent in most diabetes case management interventions examined. Nurse-led case management provides an effective clinical strategy for poorly controlled diabetes based on a meta-analysis of clinical trials focusing on blood glucose control.
我们对报告糖尿病病例管理干预措施的研究进行了荟萃分析，以检验病例管理对血糖控制（HbA1c）的影响。用于搜索的数据库包括 Medline、PubMed、Cochrane EPOC、护理学及相关健康文献累积索引数据库指南（CINAHL）和心理信息。使用随机效应模型计算了效应大小的综合估计值，并进行了亚组分析。有 29 项重要研究涉及 9397 名患者，有足够的数据进行分析。患者平均年龄为 63.2 岁，49%为男性，种族/民族为 54%的白人。91%的研究关注 2 型糖尿病。结果显示，病例管理干预对对照组或基线 HbA1c 的总体效应显著（ES=0.86，95%CI：0.52-1.19，Z=5.0，p<0.001）。这相当于平均 HbA1c 降低 0.89（95%CI：0.63-1.15）。亚组分析表明，临床环境、团队组成和基线 HbA1c 是效应大小的重要预测因素，但糖尿病自我管理教育不是，因为它在大多数检查的糖尿病病例管理干预措施中描述较差或缺失。基于对关注血糖控制的临床试验的荟萃分析，护士主导的病例管理为控制不佳的糖尿病提供了有效的临床策略。
