Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan.
BMJ Open. 2022 Mar 7;12(3):e055529. doi: 10.1136/bmjopen-2021-055529.
This study aimed to investigate the efficacy of providing education on injection technique to patients with diabetes with lipohypertrophy (LH).
We conducted a systematic review and meta-analysis.
We included patients with diabetes who use insulin and have LH, and excluded patients without LH. We performed a literature search on CENTRAL, MEDLINE, EMBASE, ICTRP and ClinicalTrials.gov in November 2021 for randomised controlled trials (RCTs). We used the revised Cochrane Risk of Bias 2 tool to evaluate the risk of bias in each outcome in each study. We then pooled the data using a random-effects model and evaluated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach.
The primary endpoints were change in total daily dose (TDD) of insulin, change in HbA1c levels and prevalence of hypoglycaemia.
We screened 580 records and included three RCTs (637 participants) in the meta-analysis. Education on injection technique may slightly increase the change of TDD of insulin (three studies, 637 participants: mean difference (MD) -6.26; 95% CI -9.42 to -3.10; p<0.001; I=38%; low certainty of evidence) and may have little to no effect on change in HbA1c but the evidence is very uncertain compared with that in the control group (three studies, 637 participants: MD -0.59; 95% CI -1.71 to 0.54; p=0.31; I=98%; very low certainty of evidence). Providing education about injection technique may have little to no effect on the prevalence of hypoglycaemia (three studies, 637 participants: risk ratio 0.44; 95% CI 0.06 to 3.13; p=0.41; I=90%; very low certainty of evidence).
The present meta-analysis suggests that injection technique education may result in a slight reduction in the TDD of insulin. However, the effect of education on HbA1c, hypoglycaemia and cured LH is uncertain.
DOI: dx.doi.org/10.17504/protocols.io.btiinkce.
本研究旨在探讨针对患有脂肪营养不良（LH）的糖尿病患者进行注射技术教育的疗效。
我们进行了系统评价和荟萃分析。
我们纳入了使用胰岛素且患有 LH 的糖尿病患者，并排除了无 LH 的患者。我们于 2021 年 11 月在 CENTRAL、MEDLINE、EMBASE、ICTRP 和 ClinicalTrials.gov 上进行了随机对照试验（RCT）的文献检索。我们使用修订后的 Cochrane 偏倚风险 2 工具评估了每项研究中每个结局的偏倚风险。然后，我们使用随机效应模型汇总数据，并使用推荐评估、制定与评价（GRADE）方法评估证据确定性。
主要结局指标为胰岛素总日剂量（TDD）的变化、HbA1c 水平的变化和低血糖的发生率。
我们筛选了 580 条记录，并将三项 RCT（637 名参与者）纳入荟萃分析。注射技术教育可能会略微增加胰岛素 TDD 的变化（三项研究，637 名参与者：平均差值（MD）-6.26；95%CI-9.42 至-3.10；p<0.001；I=38%；低确定性证据），且对 HbA1c 的变化可能几乎没有影响，但与对照组相比，证据非常不确定（三项研究，637 名参与者：MD-0.59；95%CI-1.71 至 0.54；p=0.31；I=98%；极低确定性证据）。提供关于注射技术的教育可能对低血糖的发生率几乎没有影响（三项研究，637 名参与者：风险比 0.44；95%CI 0.06 至 3.13；p=0.41；I=90%；极低确定性证据）。
本荟萃分析表明，注射技术教育可能会导致胰岛素 TDD 略有减少。然而，教育对 HbA1c、低血糖和治愈 LH 的效果尚不确定。
DOI：dx.doi.org/10.17504/protocols.io.btiinkce。
