Shifa College of Nursing, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
Department of Physiological Nursing, School of Nursing and Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States.
Front Public Health. 2022 Oct 28;10:994766. doi: 10.3389/fpubh.2022.994766. eCollection 2022.
Patient-centered care in diabetes self-management might be a significant factor in improving health outcomes of adults with type 2 diabetes, yet the supporting evidence is inadequate. This review aimed at assessing the effectiveness of patient-centered self-management care interventions on glycemic control (HbA1c) and self-care behaviors compared with usual care.
CINAHL, PubMed, Cochrane Library, Google Scholar, and the HEC Digital Library were searched for studies in English language that assessed patient-centered self-management educational and/or behavioral interventions in adults aged 18 years or older with type 2 diabetes from 2005 to 2020. Interventional studies with at least 3 months of follow-up and reporting on self-care outcomes such as glycemic control (HbA1c) and self-care behaviors including diet control, physical activity, foot care, and medication adherence were included.
Of 168 identified records, 24 were found eligible comprising 20 RCTs and four QESs with total 4,083 participants. The meta-analysis involved 19 RCTs that provided enough information for a pooled estimate of HbA1c. Compared with the control group, patient-centered self-management interventions significantly lowered HbA1c, -0.56 (95% CI -0.79, -0.32). Stratified analysis for HbA1c with respect to various aspects of intervention showed larger effects in interventions employing both educational and behavioral components, -0.66 (95% CI -0.97, -0.34); spanned over shorter (<03 months) duration, -0.85 (95% CI -1.28, -0.43); administered by nurses, -0.80 (95% CI -1.44, -0.16); and delivered in community settings -0.70 (95% CI -1.14, -0.26).
This systematic review provided evidence supporting the effectiveness of patient-centered self-management care interventions in improving glycemic control and self-care behaviors in adults with type 2 diabetes and identified key features of intervention contributing toward success.
在 2 型糖尿病患者的自我管理中实施以患者为中心的护理可能是改善其健康结局的重要因素，但目前的证据还不够充分。本研究旨在评估与常规护理相比，以患者为中心的自我管理护理干预在血糖控制（HbA1c）和自我护理行为方面的效果。
检索了 CINAHL、PubMed、Cochrane 图书馆、Google Scholar 和 HEC 数字图书馆中 2005 年至 2020 年间以英语发表的评估 2 型糖尿病成人患者接受以患者为中心的自我管理教育和/或行为干预的研究。纳入了干预时间至少 3 个月并报告自我护理结局（如血糖控制（HbA1c））和自我护理行为（包括饮食控制、体育锻炼、足部护理和药物依从性）的干预性研究。
在 168 条记录中，有 24 条符合纳入标准，包括 20 项 RCT 和 4 项 QES，共纳入 4083 名参与者。Meta 分析纳入了 19 项提供 HbA1c 汇总估计值所需信息的 RCT。与对照组相比，以患者为中心的自我管理干预显著降低了 HbA1c，降低了 0.56（95%CI-0.79，-0.32）。针对干预各方面的 HbA1c 分层分析显示，同时采用教育和行为成分的干预效果更大，降低了 0.66（95%CI-0.97，-0.34）；干预时间较短（<03 个月），降低了 0.85（95%CI-1.28，-0.43）；由护士管理，降低了 0.80（95%CI-1.44，-0.16）；在社区环境中实施，降低了 0.70（95%CI-1.14，-0.26）。
本系统评价提供了证据支持以患者为中心的自我管理护理干预在改善 2 型糖尿病成人患者血糖控制和自我护理行为方面的有效性，并确定了促成干预成功的关键特征。
