School of Nursing, Yale University, New Haven, Connecticut.
M. Louis Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania.
Diabetes Educ. 2020 Dec;46(6):514-526. doi: 10.1177/0145721720965464.
The purpose of this umbrella review was to synthesize the evidence from published systematic reviews on the effectiveness of text message programs for adults with type 2 diabetes (T2DM) on glycemic management (A1C), self-management, and other clinical outcomes. The effect of directionality of the program was also explored.
A systematic search was conducted using multiple databases. Inclusion criteria were systematic review of text message programs for adults with T2DM, evaluated A1C, and English language. Quality assessment was completed using AMSTAR-2 guidelines. Data were extracted by multiple coders, and results were synthesized.
The final sample included 9 systematic reviews published between 2011 and 2019, with 72 unique international studies. Text message programs focused on diabetes self-management and reducing health risks through educational and motivational content with some providing personalized feedback. A meta-analysis of program effect on A1C was conducted in 5 reviews with a pooled difference in A1C from -0.38% to -0.8%. Adults with T2DM of shorter duration and lower A1C had better treatment effects. Evidence on unidirectional versus bidirectional programs is conflicting; however, both improve outcomes. Evidence of text message programs targeting medication engagement was inconclusive. Some programs improved blood pressure, lipids, self-management, self-efficacy, and health behaviors. High satisfaction and an average of 9.6% to 18.7% attrition was reported.
Text messaging programs can improve T2DM outcomes, are a highly accessible mode of communication, are relatively inexpensive, and are an underutilized adjunct to clinical care.
本综述旨在综合已发表的关于短信程序对 2 型糖尿病（T2DM）成人血糖管理（A1C）、自我管理和其他临床结局的有效性的系统评价证据。还探讨了方案的方向性效果。
使用多个数据库进行系统搜索。纳入标准为针对 T2DM 成人的短信程序的系统评价，评估 A1C，且为英文。使用 AMSTAR-2 指南进行质量评估。由多名编码员提取数据，并进行综合。
最终样本包括 2011 年至 2019 年间发表的 9 项系统评价，共有 72 项独特的国际研究。短信程序侧重于通过教育和激励内容进行糖尿病自我管理和降低健康风险，有些还提供个性化反馈。对 5 项综述中的方案对 A1C 的影响进行了荟萃分析，汇总 A1C 的差异为-0.38%至-0.8%。A1C 较低且病程较短的 T2DM 成人的治疗效果更好。关于单向与双向方案的证据相互矛盾；然而，两者都能改善结局。针对药物治疗参与的短信程序的证据尚无定论。一些程序改善了血压、血脂、自我管理、自我效能和健康行为。报告了较高的满意度和平均 9.6%至 18.7%的退出率。
短信程序可以改善 T2DM 结局，是一种高度可及的沟通方式，相对便宜，且是临床护理的一种未充分利用的辅助手段。
