Carpenter Roger, DiChiacchio Toni, Barker Kendra
West Virginia University School of Nursing, Morgantown, WV, 26506, USA.
Faculty Practice & Community Engagement, West Virginia University, Morgantown, WV, 26506, USA.
Int J Nurs Sci. 2018 Dec 14;6(1):70-91. doi: 10.1016/j.ijnss.2018.12.002. eCollection 2019 Jan 10.
Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage. Since the management of diabetes is mainly accomplished by patients and families, self-management has become the mainstay of diabetes care. However, a significant proportion of patients fail to engage in adequate self-management. A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes?
PURPOSE/OBJECTIVES: The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with Type II diabetes mellitus.
An integrative review design, with a comprehensive methodological approach of reviews, allowing inclusion of experimental and non-experimental studies.
A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycArtiCLES, and PsycInfo. The final number of papers used for this review were: motivational interviewing (6), peer support/coaching (10), problem solving therapy (3), technology-based interventions (30), lifestyle modification programs (7), patient education (11), mindfulness (3), and cognitive behavioral therapy (5).
Studies were examined from seventeen countries including a broad range of cultures and ethnicities. While interventions have shown mixed results in all interventional categories, many studies do support small to modest improvements in physiologic, behavioral, and psychological outcome measures. Considerable heterogeneity of interventions exists. The most commonly reported physiologic measure was HbA1c level. Outcome measures were collected mostly at 6 and 12 months. Duration of most research was limited to one year.
Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes, from offering suggestions for improving care, to stimulating new questions for research. However, implications for clinical practice remain inconclusive, and limitations in existing research suggest caution in interpreting results of studies.
2型糖尿病已被认定为最难管理的慢性病之一。由于糖尿病的管理主要由患者及其家庭完成，自我管理已成为糖尿病护理的支柱。然而，相当一部分患者未能进行充分的自我管理。一个首要的研究问题是干预措施如何影响2型糖尿病患者的自我管理行为？
本整合性综述的目的是对支持2型糖尿病患者进行糖尿病自我管理的干预措施进行总结和批判性分析。
采用整合性综述设计，运用全面的综述方法，纳入实验性和非实验性研究。
通过EBSCOhost在以下数据库进行全面检索：《学术搜索完整版》《护理学与健康照护领域数据库》《健康资源：护理/学术版》《医学索引数据库》《心理学文摘》和《心理学全文数据库》。本综述最终使用的论文数量为：动机性访谈（6篇）、同伴支持/辅导（10篇）、问题解决疗法（3篇）、基于技术的干预措施（30篇）、生活方式改变项目（7篇）、患者教育（11篇）、正念（3篇）以及认知行为疗法（5篇）。
所审查的研究来自包括广泛文化和种族的17个国家。虽然干预措施在所有干预类别中都显示出好坏参半的结果，但许多研究确实支持生理、行为和心理结果指标有小到中等程度的改善。干预措施存在相当大的异质性。最常报告的生理指标是糖化血红蛋白水平。结果指标大多在6个月和12个月时收集。大多数研究的持续时间限于一年。
探索自我管理干预措施影响的研究对2型糖尿病患者的护理做出了重大贡献，从提供改善护理的建议到激发新的研究问题。然而，对临床实践的影响仍不明确，现有研究的局限性表明在解释研究结果时应谨慎。
