数字干预自我管理教育在 1 型和 2 型糖尿病中的应用：系统评价和荟萃分析。
Digital interventions self-management education for type 1 and 2 diabetes: A systematic review and meta-analysis.
机构信息
Master Program in Global Health and Development Department, College of Public Health, Taipei Medical University, Taipei City, Taiwan; Nkhata Bay District Hospital, Nkhata Bay District Health Office, Nkhata Bay, Mkondezi, Malawi.
Master Program in Global Health and Development Department, College of Public Health, Taipei Medical University, Taipei City, Taiwan.
出版信息
Comput Methods Programs Biomed. 2021 Oct;210:106370. doi: 10.1016/j.cmpb.2021.106370. Epub 2021 Aug 26.
OBJECTIVE
To describe and assess digital health-led diabetes self-management education and support (DSMES) effectiveness in improving glycosylated hemoglobin, diabetes knowledge, and health-related quality of life (HrQoL) of Type 1 and 2 Diabetes in the past 10 years.
DESIGN
Systematic Review and Meta-Analysis. The protocol was registered on PROSPERO registration number CRD42019139884.
DATA SOURCES
PubMed, EMBASE, Cochrane library, Web of Science, and Scopus between January 2010 and August 2019. Study Selection and Appraisal: Randomized control trials of digital health-led DSMES for Type 1 (T1DM) or 2 (T2DM) diabetes compared to usual care were included. Outcomes were change in HbA1c, diabetes knowledge, and HrQoL. Cochrane Risk of Bias 2.0 tool was used to assess bias and GRADEpro for overall quality. The analysis involved narrative synthesis, subgroup and pooled meta-analyses.
RESULTS
From 4286 articles, 39 studies (6861 participants) were included. Mean age was 51.62 years, range (13-70). Meta-analysis revealed intervention effects on HbA1c for T2DM with difference in means (MD) from baseline -0.480% (-0.661, -0.299), I75% (6 months), -0.457% (-0.761, -0.151), I 81% (12 months), and for T1DM -0.41% (-1.022, 0.208) I 83% (6 months), -0.03% (-0.210, 0.142) I 0% (12 months). Few reported HrQoL with Hedges' g 0.183 (-0.039, 0.405), I 0% (6 months), 0.153 (-0.060, 0.366), I 0% (12 months) and diabetes knowledge with Hedges' g 1.003 (0.068, 1.938), I 87% (3 months).
CONCLUSION
Digital health-led DSMES are effective in improving HbA1c and diabetes knowledge, notably for T2DM. Research shows non-significant changes in HrQoL. Intervention effect on HbA1c was more impressive if delivered through mobile apps or patient portals. Further research is needed on the impact of DSMES on these outcomes, especially for newly diagnosed diabetes patients.
目的
描述并评估过去 10 年中，基于数字健康的糖尿病自我管理教育和支持（DSMES）在改善 1 型和 2 型糖尿病患者糖化血红蛋白、糖尿病知识和健康相关生活质量（HrQoL）方面的有效性。
设计
系统综述和荟萃分析。该方案已在 PROSPERO 注册，注册号为 CRD42019139884。
数据来源
2010 年 1 月至 2019 年 8 月间，PubMed、EMBASE、Cochrane 图书馆、Web of Science 和 Scopus 数据库。
研究选择和评估
纳入了比较 1 型（T1DM）或 2 型（T2DM）糖尿病患者基于数字健康的 DSMES 与常规护理的随机对照试验。结局为糖化血红蛋白（HbA1c）、糖尿病知识和 HrQoL 的变化。采用 Cochrane 偏倚风险 2.0 工具评估偏倚，并用 GRADEpro 评估整体质量。分析包括叙述性综合分析、亚组和汇总荟萃分析。
结果
从 4286 篇文章中，共纳入 39 项研究（6861 名参与者）。平均年龄为 51.62 岁，范围为 13-70 岁。荟萃分析显示，干预对 T2DM 的 HbA1c 有影响，与基线相比，差异有统计学意义（MD）为-0.480%（-0.661，-0.299），I75%（6 个月），-0.457%（-0.761，-0.151），I81%（12 个月），而对 T1DM 的 HbA1c 影响为-0.41%（-1.022，0.208），I83%（6 个月），-0.03%（-0.210，0.142），I0%（12 个月）。只有少数研究报告了 HrQoL，Hedges'g 值为 0.183（-0.039，0.405），I0%（6 个月），0.153（-0.060，0.366），I0%（12 个月），而糖尿病知识的 Hedges'g 值为 1.003（0.068，1.938），I87%（3 个月）。
结论
基于数字健康的 DSMES 可有效改善糖化血红蛋白和糖尿病知识，尤其对 2 型糖尿病患者效果显著。研究表明，对生活质量的影响无统计学意义。如果通过移动应用程序或患者门户提供，干预对 HbA1c 的影响更为显著。需要进一步研究 DSMES 对这些结局的影响，尤其是对新诊断的糖尿病患者。
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