Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Mayo Clinic School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
J Gen Intern Med. 2018 Apr;33(4):524-532. doi: 10.1007/s11606-017-4237-1. Epub 2017 Dec 18.
Patients with limited English proficiency (LEP) and type 2 diabetes mellitus (T2DM) have several health disparities, including suboptimal patient-provider interactions, poorer glycemic control, and T2DM complications. Understanding existing interventions for improving T2DM outcomes in this population is critical for reducing disparities.
We performed a systematic review of randomized controlled trials (RCTs) and observational studies examining the effectiveness of interventions in improving T2DM outcomes among patients with LEP in North America. Quality was assessed using the Cochrane risk of bias tool for RCTs and the Newcastle-Ottawa Scale for non-RCT studies. Meta-analysis was conducted using the random-effects model.
Fifty-four studies, 39 of which reported sufficient data for meta-analysis of glycemic control, were included. The interventions were associated with a statistically significant reduction in hemoglobin A (HbA) (weighted difference in means, -0.84% [95% CI, -0.97 to -0.71]) that was, however, very heterogeneous across studies (I = 95.9%). Heterogeneity was explained by study design (lower efficacy in RCTs than non-RCTs) and by intervention length and delivery mode (greater reduction in interventions lasting <6 months or delivered face-to-face); P < 0.05 for all three covariates. The interventions were also associated in most studies with improvement in knowledge, self-efficacy in diabetes management, quality of life, blood pressure, and low-density lipoprotein cholesterol.
Multiple types of interventions are available for T2DM management in patients with LEP. Multicomponent interventions delivered face-to-face seem most effective for glycemic control. More research is needed to better understand other aspects of multicomponent interventions that are critical for improving important outcomes among patients with T2DM and LEP.
英语水平有限（LEP）的 2 型糖尿病（T2DM）患者存在多种健康差异，包括医患互动不佳、血糖控制较差和 T2DM 并发症。了解针对这一人群改善 T2DM 结局的现有干预措施对于减少差异至关重要。
我们对北美 LEP 患者的 T2DM 结局改善干预措施的随机对照试验（RCT）和观察性研究进行了系统评价。使用 Cochrane 偏倚风险工具评估 RCT 的质量，使用 Newcastle-Ottawa 量表评估非 RCT 研究的质量。使用随机效应模型进行荟萃分析。
共纳入 54 项研究，其中 39 项报告了足够的数据可进行血糖控制的荟萃分析。干预措施与糖化血红蛋白（HbA）的统计学显著降低相关（加权均值差异，-0.84% [95% CI，-0.97 至-0.71]），但研究间存在很大的异质性（I=95.9%）。异质性由研究设计（RCT 中的疗效较低，而非 RCT）和干预持续时间和交付模式解释（持续时间<6 个月或面对面交付的干预措施降低幅度更大）；所有三个协变量的 P 值均<0.05。在大多数研究中，这些干预措施还与知识、糖尿病管理自我效能、生活质量、血压和低密度脂蛋白胆固醇的改善相关。
有多种类型的干预措施可用于 LEP 患者的 T2DM 管理。面对面交付的多组分干预措施似乎对血糖控制最有效。需要更多的研究来更好地了解改善 T2DM 和 LEP 患者重要结局的多组分干预措施的其他方面。
