Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
Diabetes Res Clin Pract. 2020 Nov;169:108480. doi: 10.1016/j.diabres.2020.108480. Epub 2020 Sep 28.
This systematic review aimed to identify the effectiveness of diabetes self-management education and support (DSMES) among adults within 12 months of diagnosis of type 2 diabetes mellitus (T2DM). We searched the Cochrane Library, MEDLINE, CINAHL, PsycINFO, ERIC, and other sources up to March 2019 to detect randomized controlled trials in the last decade based on the global guidelines' definition of DSMES. Data were categorized into biomedical, psychosocial, and behavioral outcomes and synthesized using a random-effects model. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. We scrutinized 12 studies that enrolled 2,386 adults with newly diagnosed T2DM. Biomedical outcomes presented the pooled effects of HbA1c -0.21% (95% confidence interval, -0.38, -0.04), body weight -2.36 kg (-5.77, 1.05), and waist circumference -1.8 cm (-5.63, 2.04) when the data from the two studies with low risk of bias were combined (N = 1,082). Psychosocial and behavioral effects were inconclusive owing to mixed results from various scales and reporting. The quality of the body of evidence was low. DSMES within 12 months of T2DM diagnosis might affect patient-centered outcomes. Further studies with higher precision using standardized measurement methods are required.
本系统评价旨在确定在诊断 2 型糖尿病（T2DM）后 12 个月内对成年人进行糖尿病自我管理教育和支持（DSMES）的效果。我们在 Cochrane 图书馆、MEDLINE、CINAHL、PsycINFO、ERIC 等数据库中进行了搜索，截至 2019 年 3 月，以全球指南对 DSMES 的定义为依据，查找了过去十年中的随机对照试验。将数据分为生物医学、心理社会和行为结果，并使用随机效应模型进行综合。使用推荐评估、制定与评价系统的分级评估质量证据。我们仔细审查了 12 项研究，这些研究共纳入了 2386 名新诊断为 T2DM 的成年人。当将两项低偏倚风险研究的数据合并（N=1082）时，生物医学结果显示 HbA1c 降低 0.21%（95%置信区间：-0.38，-0.04），体重减轻 2.36kg（-5.77，1.05），腰围减少 1.8cm（-5.63，2.04）。由于来自不同量表和报告的结果不一致，心理社会和行为影响尚不确定。证据质量低。T2DM 诊断后 12 个月内的 DSMES 可能会影响以患者为中心的结果。需要使用标准化测量方法进行更精确、高质量的进一步研究。
