Schmidt C B, van Loon B J Potter, Vergouwen A C M, Snoek F J, Honig A
Departments of Psychiatry, Amsterdam, The Netherlands.
Departments of Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Diabet Med. 2018 Jun 13. doi: 10.1111/dme.13709.
The clinical relevance of diabetes-distress is increasingly recognized, but little is known about the efficacy of interventions specifically targeted to treat elevated diabetes-distress. Therefore, this systematic review sought to determine the efficacy of psychological interventions aimed at treating elevated diabetes-distress in people with Type 1 or Type 2 diabetes.
We systematically searched literature from five databases. Randomized controlled trials (RCTs) with an English abstract, describing the results of a psychological intervention in adults with diabetes were included. Articles were eligible for inclusion if the primary outcome was diabetes-distress measured by the Problem Areas in Diabetes Scale (PAID-5/PAID-20) or the Diabetes Distress Scale (DDS-17). Only mean group diabetes-distress values above cut-off at baseline or the results of a subgroup above cut-off (PAID-5 ≥ 8, PAID-20 ≥ 40 or DDS-17 ≥ 3) were included.
The search yielded 8907 articles. After removing 2800 duplicates, 6107 articles remained. Titles and abstracts were screened, leaving 394 potential articles of interest, nine of which were RCTs. In a random-effects meta-analysis, the pooled effect size for diabetes-distress was 0.48 (Cohen's d), Z = 3.91, P < 0.0001. Statistical heterogeneity was I² = 46.67% (confidence intervals 45.06% to 48.28%). Diabetes-tailored psychological interventions reduced HbA (Cohen's d = 0.57), whereas mindfulness-based interventions did not (Cohen's d = 0.11).
This systematic review shows that specifically diabetes-tailored psychological interventions are effective in reducing elevated diabetes-distress and HbA . More rigorous studies are warranted to establish the full potential of these interventions. PROSPERO database registration ID: CRD42017075290.
糖尿病困扰的临床相关性日益受到认可，但针对治疗糖尿病困扰升高的干预措施的疗效却知之甚少。因此，本系统评价旨在确定针对治疗1型或2型糖尿病患者糖尿病困扰升高的心理干预措施的疗效。
我们系统检索了五个数据库中的文献。纳入有英文摘要、描述对成年糖尿病患者进行心理干预结果的随机对照试验（RCT）。如果主要结局是通过糖尿病问题领域量表（PAID - 5/PAID - 20）或糖尿病困扰量表（DDS - 17）测量的糖尿病困扰，则文章符合纳入标准。仅纳入基线时高于临界值的组平均糖尿病困扰值或高于临界值的亚组结果（PAID - 5≥8，PAID - 20≥40或DDS - 17≥3）。
检索共获得8907篇文章。去除2800篇重复文章后，剩余6107篇文章。对标题和摘要进行筛选，留下394篇潜在感兴趣的文章，其中9篇为RCT。在随机效应荟萃分析中，糖尿病困扰的合并效应量为0.48（科恩d值），Z = 3.91，P < 0.0001。统计异质性为I² = 46.67%（置信区间45.06%至48.28%）。针对糖尿病的心理干预降低了糖化血红蛋白（HbA）（科恩d值 = 0.57），而基于正念的干预措施则未降低（科恩d值 = 0.11）。
本系统评价表明，专门针对糖尿病的心理干预措施在降低糖尿病困扰升高和糖化血红蛋白方面是有效的。有必要进行更严格的研究以确定这些干预措施的全部潜力。国际前瞻性系统评价注册库（PROSPERO）数据库注册号：CRD42017075290。
