Knox Emily C L, Quirk Helen, Glazebrook Cris, Randell Tabitha, Blake Holly
University of Nottingham, School of Health Sciences, Nottingham, UK.
Sheffield Hallam University, Centre for Sport and Exercise Science, Sheffield, UK.
BMC Endocr Disord. 2019 Jan 10;19(1):7. doi: 10.1186/s12902-018-0331-6.
The role of technology in the self-management of type 1 diabetes mellitus (T1DM) among children and young people is not well understood. Interventions should aim to improve key diabetes self-management behaviours (self-management of blood glucose, insulin administration, physical activity and dietary behaviours) and prerequisites (psychological outcomes and HbA1c) highlighted in the UK guidelines of the National Institute for Health and Care Excellence (NICE) for management of T1DM. The purpose was to identify evidence to assess the effectiveness of technological tools in promoting aspects of these guidelines amongst children and young people.
A systematic review of English language articles was conducted using the following databases: Web of Science, PubMed, Scopus, NUSearch, SAGE Journals, SpringerLink, Google Scholar, Science Direct, Sport Discus, Embase, Psychinfo and Cochrane Trials. Search terms included paediatric, type one diabetes, technology, intervention and various synonyms. Included studies examined interventions which supplemented usual care with a health care strategy primarily delivered through a technology-based medium (e.g. mobile phone, website, activity monitor) with the aim of engaging children and young people with T1DM directly in their diabetes healthcare. Studies did not need to include a comparator condition and could be randomised, non-randomised or cohort studies but not single-case studies.
Of 30 included studies (21 RCTs), the majority measured self-monitoring of blood glucose monitoring (SMBG) frequency, clinical indicators of diabetes self-management (e.g. HbA1c) and/or psychological or cognitive outcomes. The most positive findings were associated with technology-based health interventions targeting SMBG as a behavioural outcome, with some benefits found for clinical and/or psychological diabetes self-management outcomes. Technological interventions were well accepted by children and young people. For the majority of included outcomes, clinical relevance was deemed to be little or none.
More research is required to assess which elements of interventions are most likely to produce beneficial behavioural outcomes. To produce clinically relevant outcomes, interventions may need to be delivered for at least 1 year and should consider targeting individuals with poorly managed diabetes. It is not possible to determine the impact of technology-based interventions on insulin administration, dietary habits and/or physical activity behaviour due to lack of evidence.
技术在儿童和青少年1型糖尿病（T1DM）自我管理中的作用尚未得到充分理解。干预措施应旨在改善英国国家卫生与临床优化研究所（NICE）T1DM管理指南中强调的关键糖尿病自我管理行为（血糖自我管理、胰岛素注射、体育活动和饮食行为）及先决条件（心理结果和糖化血红蛋白）。目的是确定证据，以评估技术工具在促进儿童和青少年遵循这些指南方面的有效性。
使用以下数据库对英文文章进行系统综述：科学引文索引、医学期刊数据库、Scopus数据库、NUSearch数据库、SAGE期刊数据库、SpringerLink数据库、谷歌学术、科学直读、体育文献数据库、荷兰医学文摘数据库、心理学文摘数据库和考科蓝对照试验中心注册库。检索词包括儿科、1型糖尿病、技术、干预及各种同义词。纳入的研究考察了主要通过基于技术的媒介（如手机、网站、活动监测器）实施的医疗保健策略对常规护理进行补充的干预措施，目的是让患有T1DM的儿童和青少年直接参与其糖尿病医疗保健。研究无需设置对照条件，可以是随机对照试验、非随机对照试验或队列研究，但不包括单病例研究。
在纳入的30项研究（21项随机对照试验）中，大多数研究测量了血糖自我监测（SMBG）频率、糖尿病自我管理的临床指标（如糖化血红蛋白）和/或心理或认知结果。最积极的研究结果与以SMBG为行为结果的基于技术的健康干预措施相关，在临床和/或心理糖尿病自我管理结果方面也发现了一些益处。技术干预措施受到儿童和青少年的广泛接受。对于大多数纳入的结果，临床相关性被认为很小或没有。
需要更多研究来评估干预措施的哪些要素最有可能产生有益的行为结果。为了产生临床相关结果，干预措施可能需要实施至少1年，并应考虑针对糖尿病管理不善的个体。由于缺乏证据，无法确定基于技术的干预措施对胰岛素注射、饮食习惯和/或体育活动行为的影响。
