McCurley Jessica L, Gutierrez Angela P, Gallo Linda C
San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
Am J Prev Med. 2017 Apr;52(4):519-529. doi: 10.1016/j.amepre.2016.10.028. Epub 2016 Dec 15.
Type 2 diabetes, prediabetes, and metabolic syndrome are highly prevalent in Hispanic individuals in the U.S. Cultural adaptations of traditional lifestyle interventions have been recommended to better reach this high-risk population. This systematic review examined the effectiveness of diabetes prevention programs for Hispanics in lowering risk for Type 2 diabetes, as evidenced by a reduction in weight or improvement in glucose regulation.
PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO were searched from database inception to June 2016 for studies that evaluated diabetes prevention trials targeting U.S. Hispanic populations. Twelve publications met criteria for inclusion.
Interventions varied substantially in length, rigor, and tailoring strategies. Five of 12 studies were RCTs. Eight studies included entirely or largely (>70%) female samples. All studies were delivered in Spanish and took place in community settings. Nine studies reported significant reductions in weight, and two in glucose regulation, post-intervention or when compared with controls. Effect sizes were small to moderate, study quality was moderate, and attrition was high in most trials. Interventions with the largest effect sizes included one or more of the following adaptations: literacy modification, Hispanic foods/recipes, cultural diabetes beliefs, family/friend participation, structured community input, and innovative experiential learning.
Culturally tailored lifestyle interventions for diabetes prevention appear to be modestly effective in reducing risk for diabetes in Hispanics in the U.S. More studies are needed that utilize randomized controlled designs, recruit Hispanic men, report intervention content and tailoring strategies systematically, and publish participant evaluation and feedback.
2型糖尿病、糖尿病前期和代谢综合征在美国西班牙裔人群中极为普遍。建议对传统生活方式干预措施进行文化适应性调整，以便更好地惠及这一高危人群。本系统评价考察了针对西班牙裔人群的糖尿病预防项目在降低2型糖尿病风险方面的有效性，证据为体重减轻或血糖调节改善。
检索了PubMed/MEDLINE、Cochrane对照试验中央注册库、科学网和PsycINFO，从建库至2016年6月，查找评估针对美国西班牙裔人群的糖尿病预防试验的研究。12篇出版物符合纳入标准。
干预措施在时长、严谨性和调整策略方面差异很大。12项研究中有5项为随机对照试验。8项研究纳入的样本全部或大部分（>70%）为女性。所有研究均以西班牙语进行，且在社区环境中开展。9项研究报告干预后或与对照组相比体重显著减轻，2项研究报告血糖调节有改善。效应量为小到中等，研究质量中等，且大多数试验中的失访率较高。效应量最大的干预措施包括以下一种或多种调整：读写能力调整、西班牙裔食物/食谱、糖尿病文化观念、家人/朋友参与、结构化社区投入以及创新体验式学习。
针对糖尿病预防的文化适应性生活方式干预措施似乎在降低美国西班牙裔人群患糖尿病风险方面有一定效果。需要开展更多研究，采用随机对照设计，招募西班牙裔男性，系统报告干预内容和调整策略，并公布参与者评估和反馈。
