Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
Health Expect. 2017 Dec;20(6):1218-1227. doi: 10.1111/hex.12546. Epub 2017 Feb 28.
To examine the effect on cardiovascular (CVD) risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes.
Electronic and manual citation searching to identify relevant randomized controlled trials (RCTs).
RCTs that compared usual care to interventions to alter consultations between practitioners and patients. The population was adults aged over 18 years with type 2 diabetes. Trials were set in primary care.
We recorded if explicit theory-based interventions were used, how consultations were measured to determine whether interventions had an effect on these and calculated weighted mean differences for CVD risk factors including glycated haemoglobin (HbA ), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C).
We included seven RCTs with a total of 2277 patients with type 2 diabetes. A range of measures of the consultation was reported, and underlying theory to explain intervention processes was generally undeveloped and poorly applied. There were no overall effects on CVD risk factors; however, trials were heterogeneous. Subgroup analysis suggested some benefit among studies in which interventions demonstrated impact on consultations; statistically significant reductions in HbA levels (weighted mean difference, -0.53%; 95% CI: [-0.77, -0.28]; P<.0001; I =46%).
Evidence of effect on CVD risk factors from interventions to alter consultations between practitioners and patients with type 2 diabetes was heterogeneous and inconclusive. This could be explained by variable impact of interventions on consultations. More research is required that includes robust measures of the consultations and better development of theory to elucidate mechanisms.
研究改变 2 型糖尿病患者医患咨询方式的干预措施对心血管（CVD）危险因素的影响。
电子和手动引文搜索，以确定相关的随机对照试验（RCT）。
将常规护理与改变医患咨询方式的干预措施进行比较的 RCT。研究对象为年龄在 18 岁以上的 2 型糖尿病成年患者。试验设置在初级保健中。
我们记录了是否使用了基于明确理论的干预措施，如何测量咨询以确定干预措施对这些咨询是否有影响，并计算了 CVD 危险因素的加权均数差，包括糖化血红蛋白（HbA1c）、收缩压（SBP）、舒张压（DBP）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）。
我们纳入了 7 项 RCT，共有 2277 名 2 型糖尿病患者。报告了一系列咨询措施，干预措施的潜在理论解释通常未得到充分发展和应用。CVD 危险因素无总体影响；然而，试验存在异质性。亚组分析表明，干预措施对咨询产生影响的研究中存在一定益处；HbA1c 水平显著降低（加权均数差，-0.53%；95%CI：[-0.77，-0.28]；P<.0001；I²=46%）。
改变 2 型糖尿病患者医患咨询方式的干预措施对 CVD 危险因素的影响证据存在异质性和不确定性。这可能是由于干预措施对咨询的影响不同。需要更多的研究，包括对咨询进行更有力的测量，并更好地发展理论以阐明机制。
