Daly Barbara, Tian Catherine Jia Lin, Scragg Robert Keith Rhodes
School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, Auckland, New Zealand.
Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
Diabetes Res Clin Pract. 2017 Sep;131:187-199. doi: 10.1016/j.diabres.2017.07.019. Epub 2017 Jul 14.
A systematic review and meta-analysis identified 42 randomised control trials comparing a nurse-led intervention with 'usual care' to quantify their effect on glycated haemoglobin (HbA1c) and major cardiovascular risk factors in diabetes patients. All relevant databases were systematically searched for publications to February 2016: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE and Cumulative Index to Nursing & Allied Health Literature (CINAHL). The 42 trials recruited 9955 diabetes patients (5022 randomised to intervention and 4933 to 'usual care'). For patients receiving the nurse-led intervention, compared with 'usual care', there were small but significant mean reductions for HbA1c [-0.28%; 95% CI -0.38%, -0.18%; p-value<0.0001, n=6920] and serum triglyceride levels [-0.27mmol/L; 95% CI -0.49, -0.06; p=0.01, n=1169], and a greater proportion of patients stopped smoking [risk ratio=2.70; 95% CI 1.35, 5.43; p=0.005, n=1890 patients]. Mean reductions for systolic [-1.84mmHg; 95% CI -3.97, -0.10; p=0.06, 4241 patients] and diastolic [-0.95mmHg; 95% CI -2.15, -0.25; p=0.12, 3811 patients] blood pressures trended towards significance. There were no significant mean reductions for body mass index or serum cholesterol. Nurse-led interventions produced greater improvements than 'usual care' for HbA1c, serum triglyceride and smoking cessation and support an increased independent role for nurses in diabetes management.
一项系统评价和荟萃分析纳入了42项随机对照试验，这些试验比较了由护士主导的干预措施与“常规护理”，以量化其对糖尿病患者糖化血红蛋白（HbA1c）和主要心血管危险因素的影响。系统检索了截至2016年2月的所有相关数据库中的出版物：医学主题词表（MEDLINE）、Cochrane对照试验中心注册库、荷兰医学文摘数据库（EMBASE）以及护理学与健康相关文献累积索引数据库（CINAHL）。这42项试验共招募了9955名糖尿病患者（5022名被随机分配至干预组，4933名被分配至“常规护理”组）。对于接受护士主导干预的患者，与“常规护理”相比，糖化血红蛋白水平有小幅度但显著的平均降低[-0.28%；95%置信区间-0.38%，-0.18%；p值<0.0001，n = 6920]，血清甘油三酯水平也有降低[-0.27mmol/L；95%置信区间-0.49，-0.06；p = 0.01，n = 1169]，并且戒烟的患者比例更高[风险比=2.70；95%置信区间1.35，5.43；p = 0.005，n = 1890例患者]。收缩压[-1.84mmHg；95%置信区间-3.97，-0.10；p = 0.06，4241例患者]和舒张压[-0.95mmHg；95%置信区间-2.15，-0.25；p = 0.12，3811例患者]的平均降低趋势接近显著。体重指数或血清胆固醇没有显著的平均降低。护士主导的干预措施在糖化血红蛋白、血清甘油三酯和戒烟方面比“常规护理”产生了更大的改善，支持护士在糖尿病管理中发挥更大的独立作用。
