Taylor Johanna, Stubbs Brendon, Hewitt Catherine, Ajjan Ramzi A, Alderson Sarah L, Gilbody Simon, Holt Richard I G, Hosali Prakash, Hughes Tom, Kayalackakom Tarron, Kellar Ian, Lewis Helen, Mahmoodi Neda, McDermid Kirstine, Smith Robert D, Wright Judy M, Siddiqi Najma
Department of Health Sciences, University of York, York, United Kingdom.
Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
PLoS One. 2017 Jan 5;12(1):e0168549. doi: 10.1371/journal.pone.0168549. eCollection 2017.
People with severe mental illness (SMI) have reduced life expectancy compared with the general population, which can be explained partly by their increased risk of diabetes. We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in people with SMI (PROSPERO registration: CRD42015015558). A systematic literature search was performed on 30/10/2015 to identify randomised controlled trials (RCTs) in adults with SMI, with or without a diagnosis of diabetes that measured fasting blood glucose or glycated haemoglobin (HbA1c). Screening and data extraction were carried out independently by two reviewers. We used random effects meta-analysis to estimate effectiveness, and subgroup analysis and univariate meta-regression to explore heterogeneity. The Cochrane Collaboration's tool was used to assess risk of bias. We found 54 eligible RCTs in 4,392 adults (40 pharmacological, 13 behavioural, one mixed intervention). Data for meta-analysis were available from 48 RCTs (n = 4052). Both pharmacological (mean difference (MD), -0.11mmol/L; 95% confidence interval (CI), [-0.19, -0.02], p = 0.02, n = 2536) and behavioural interventions (MD, -0.28mmol//L; 95% CI, [-0.43, -0.12], p<0.001, n = 956) were effective in lowering fasting glucose, but not HbA1c (pharmacological MD, -0.03%; 95% CI, [-0.12, 0.06], p = 0.52, n = 1515; behavioural MD, 0.18%; 95% CI, [-0.07, 0.42], p = 0.16, n = 140) compared with usual care or placebo. In subgroup analysis of pharmacological interventions, metformin and antipsychotic switching strategies improved HbA1c. Behavioural interventions of longer duration and those including repeated physical activity had greater effects on fasting glucose than those without these characteristics. Baseline levels of fasting glucose explained some of the heterogeneity in behavioural interventions but not in pharmacological interventions. Although the strength of the evidence is limited by inadequate trial design and reporting and significant heterogeneity, there is some evidence that behavioural interventions, antipsychotic switching, and metformin can lead to clinically important improvements in glycaemic measurements in adults with SMI.
与普通人群相比，重度精神疾病（SMI）患者的预期寿命缩短，这部分可归因于他们患糖尿病的风险增加。我们进行了一项荟萃分析，以确定药物和非药物干预措施对改善SMI患者血糖控制的临床效果（国际前瞻性系统评价注册库注册号：CRD42015015558）。于2015年10月30日进行了系统的文献检索，以确定针对成年SMI患者（无论是否诊断为糖尿病）的随机对照试验（RCT），这些试验测量空腹血糖或糖化血红蛋白（HbA1c）。两名审阅者独立进行筛选和数据提取。我们使用随机效应荟萃分析来估计效果，并进行亚组分析和单变量荟萃回归以探讨异质性。使用Cochrane协作组的工具评估偏倚风险。我们在4392名成年人中发现了54项符合条件的RCT（40项药物治疗、13项行为干预、1项混合干预）。48项RCT（n = 4052）可提供荟萃分析的数据。与常规治疗或安慰剂相比，药物干预（平均差（MD），-0.11mmol/L；95%置信区间（CI），[-0.19, -0.02]，p = 0.02，n = 2536）和行为干预（MD，-0.28mmol/L；95%CI，[-0.43, -0.12]，p<0.001，n = 956）均能有效降低空腹血糖，但对HbA1c无效（药物干预MD，-0.03%；95%CI，[-0.12, 0.06]，p = 0.52，n = 1515；行为干预MD，0.18%；95%CI，[-0.07, 0.42]，p = 0.16，n = 140）。在药物干预的亚组分析中，二甲双胍和抗精神病药物换药策略可改善HbA1c。持续时间较长且包括重复体育活动的行为干预对空腹血糖的影响大于不具备这些特征的干预措施。空腹血糖的基线水平解释了行为干预中的部分异质性，但未解释药物干预中的异质性。尽管证据强度因试验设计和报告不充分以及显著的异质性而受到限制，但有证据表明行为干预、抗精神病药物换药和二甲双胍可使成年SMI患者的血糖测量值在临床上得到重要改善。
