Winkley Kirsty, Upsher Rebecca, Stahl Daniel, Pollard Daniel, Brennan Alan, Heller Simon R, Ismail Khalida
Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
BMJ Open Diabetes Res Care. 2020 Apr;8(1). doi: 10.1136/bmjdrc-2019-001150.
The quality of evidence that psychological interventions are effective in improving glycemic control in adults with type 2 diabetes (T2D) is weak.We conducted a systematic review and meta-analysis of psychological interventions in T2D to assess whether their effectiveness in improving glycemic levels has improved over the past 30 years. We applied the protocol of a systematic review and aggregate meta-analysis conducted to January 2003. We added network meta-analysis (NMA) to compare intervention and control group type against usual care. MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Cochrane Controlled Trials Database, Web of Science, and Dissertation Abstracts International were searched from January 2003 to July 2018. Only randomized controlled trials (RCT) of psychological interventions for adults with T2D reported in any language were included. The primary outcome was change in glycemic control (glycated hemoglobin (HbA1c) in mmol/mol). Data were extracted from study reports and authors were contacted for missing data.94 RCTs were eligible for inclusion in the systematic review since the last review. In 70 RCTs (n=14 796 participants) the pooled mean difference in HbA1c in those randomized to psychological intervention compared with control group was -0.19 (95% CI -0.25 to -0.12), equivalent to a reduction in HbA1c of 3.7 mmol/mol, with moderate heterogeneity across studies (I=64.7%, p<0.001). NMA suggested the probability of intervention effectiveness is highest for self-help materials, cognitive-behavioral therapy, and counseling, compared with usual care. Limitations of this study include that there is a possibility that some studies may have been missed if diabetes did not appear in the title or abstract.The effectiveness of psychological interventions for adults with T2D have minimal clinical benefit in improving glycemic control. PROSPERO REGISTRATION NUMBER: CRD42016033619.
心理干预对改善2型糖尿病（T2D）成年患者血糖控制有效的证据质量较弱。我们对T2D患者的心理干预进行了系统评价和荟萃分析，以评估在过去30年中其改善血糖水平的有效性是否有所提高。我们采用了截至2003年1月进行的系统评价和汇总荟萃分析方案。我们增加了网络荟萃分析（NMA），以比较干预组和对照组类型与常规护理的效果。检索了2003年1月至2018年7月期间的MEDLINE、护理及相关健康文献累积索引、PsycINFO、EMBASE、Cochrane对照试验数据库、科学引文索引和国际学位论文摘要。仅纳入以任何语言报道的针对T2D成年患者的心理干预随机对照试验（RCT）。主要结局是血糖控制的变化（糖化血红蛋白（HbA1c），单位为mmol/mol）。从研究报告中提取数据，并就缺失数据与作者联系。自上次综述以来，有94项RCT符合纳入系统评价的条件。在70项RCT（n = 14796名参与者）中，随机接受心理干预的患者与对照组相比，HbA1c的合并平均差值为-0.19（95%CI -0.25至-0.12），相当于HbA1c降低3.7 mmol/mol，各研究间存在中度异质性（I = 64.7%，p < 0.001）。NMA表明，与常规护理相比，自助材料、认知行为疗法和咨询的干预有效性概率最高。本研究的局限性包括，如果糖尿病未出现在标题或摘要中，可能会遗漏一些研究。心理干预对T2D成年患者改善血糖控制的有效性临床益处极小。PROSPERO注册号：CRD42016033619。
