Mathiesen Anne Sophie, Egerod Ingrid, Jensen Tonny, Kaldan Gudrun, Langberg Henning, Thomsen Thordis
Department of Endocrinology, Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark,
Intensive Care Unit 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Diabetes Metab Syndr Obes. 2018 Dec 17;12:19-33. doi: 10.2147/DMSO.S179301. eCollection 2019.
Diabetes distress (DD) disproportionately affects vulnerable people with type 2 diabetes mellitus and interventions targeting this population are therefore relevant. A systematic review and meta-analysis was performed to assess the evidence for an effect of psychosocial interventions for reducing DD, and, secondly HbA1c, depression, and health-related quality of life in vulnerable people with type 2 diabetes mellitus. Vulnerability encompasses poor glycemic control (HbA1c >7.5%) and at least one additional risk factor for poor diabetes outcomes such as low educational level, comorbidity, and risky lifestyle behavior. The interventions should be theoretically founded and include cognition- or emotion-focused elements. We systematically searched four databases for articles published between January 1995 and March 2018. Eighteen studies testing a variety of psychosocial interventions in 4,066 patients were included. We adhered to the Cochrane methodology and PRISMA guidelines. Review Manager 5.3 was used for data extraction and risk of bias assessment, and Grades of Recommendation, Assessment, Development and Evaluation for assessing the quality of the evidence. Data were pooled using the fixed or random effects method as appropriate. We investigated effects of individual vs group, intensive vs brief interventions, and interventions with and without motivational interviewing in subgroup analyses. To assess the robustness of effect estimates, sensitivity analyses excluding studies with high risk of bias and attrition >20% were conducted. We found low to moderate quality evidence for a significant small effect of psychosocial interventions on DD, and very low to moderate quality evidence for no effect on HbA1c, both outcomes assessed at 3, 6, 12, and 24 months follow-up. The effect on depression was small, while there was no effect on health-related quality of life. Exploratory subgroup analyses suggested that interventions using motivational interviewing and individual interventions were associated with incremental effects on DD. Likewise, intensive interventions were associated with significant reductions in both DD and HbA1c.
糖尿病困扰（DD）对2型糖尿病弱势群体的影响尤为严重，因此针对这一人群的干预措施具有重要意义。我们进行了一项系统评价和荟萃分析，以评估心理社会干预对减轻2型糖尿病弱势群体的糖尿病困扰以及糖化血红蛋白（HbA1c）、抑郁和健康相关生活质量影响的证据。弱势群体包括血糖控制不佳（HbA1c>7.5%）以及至少一项其他糖尿病不良结局的风险因素，如低教育水平、合并症和危险的生活方式行为。干预措施应有理论依据，并包括认知或情感聚焦元素。我们系统检索了四个数据库，查找1995年1月至2018年3月发表的文章。纳入了18项对4066例患者进行各种心理社会干预测试的研究。我们遵循Cochrane方法和PRISMA指南。使用Review Manager 5.3进行数据提取和偏倚风险评估，并使用推荐分级、评估、制定和评价系统来评估证据质量。根据情况使用固定效应或随机效应方法合并数据。我们在亚组分析中研究了个体与团体、强化与简短干预以及有无动机性访谈的干预措施的效果。为评估效应估计的稳健性，我们进行了敏感性分析，排除了偏倚风险高和失访率>20%的研究。我们发现，心理社会干预对糖尿病困扰有显著微小影响的证据质量低至中等，而对糖化血红蛋白无影响的证据质量极低至中等，这两个结局均在3、6、12和24个月随访时评估。对抑郁的影响较小，而对健康相关生活质量没有影响。探索性亚组分析表明，使用动机性访谈的干预措施和个体干预措施与糖尿病困扰的增量效应相关。同样，强化干预措施与糖尿病困扰和糖化血红蛋白的显著降低相关。
