Litchfield Ian, Barrett Timothy, Hamilton-Shield Julian P, Moore T H M, Narendran Parth, Redwood Sabi, Searle Aidan, Uday Suma, Wheeler Jess, Greenfield Sheila
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
Diabet Med. 2023 Apr;40(4):e15035. doi: 10.1111/dme.15035. Epub 2023 Jan 6.
Facilitated self-management support programmes have become central to the treatment of chronic diseases including diabetes. For many children and young people with diabetes (CYPD), the impact on glycated haemoglobin (HbA ) and a range of self-management behaviours promised by these programmes remain unrealised. This warrants an appraisal of current thinking and the existing evidence to guide the development of programmes better targeted at this age group.
Create a narrative review of systematic reviews produced in the last 3 years that have explored the impact on CYPD of the four key elements of self-management support programmes: education, instruction and advice including peer support; psychological counselling via a range of therapies; self-monitoring, including diaries and telemetric devices; and telecare, the technology-enabled follow-up and support by healthcare providers.
Games and gamification appear to offer a promising means of engaging and educating CYPD. Psychological interventions when delivered by trained practitioners, appear to improve HbA and quality of life although effect sizes were small. Technology-enabled interactive diaries can increase the frequency of self-monitoring and reduce levels of HbA . Telecare provided synchronously via telephone produced significant improvements in HbA .
The cost-effective flexibility of increasing the reliance on technology is an attractive proposition; however, there are resource implications for digital connectivity in underserved populations. The need remains to improve the understanding of which elements of each component are most effective in a particular context, and how to optimise the influence and input of families, caregivers and peers.
促进自我管理支持项目已成为包括糖尿病在内的慢性病治疗的核心。对于许多患有糖尿病的儿童和年轻人（CYPD）来说，这些项目所承诺的对糖化血红蛋白（HbA）和一系列自我管理行为的影响尚未实现。这就需要对当前的想法和现有证据进行评估，以指导针对该年龄组的更有针对性的项目的开发。
对过去3年进行的系统评价进行叙述性综述，这些系统评价探讨了自我管理支持项目的四个关键要素对CYPD的影响：教育、指导和建议，包括同伴支持；通过一系列疗法进行心理咨询；自我监测，包括日记和遥测设备；以及远程护理，即医疗保健提供者通过技术进行的随访和支持。
游戏和游戏化似乎为吸引和教育CYPD提供了一种有前景的手段。由训练有素的从业者提供的心理干预似乎能改善HbA和生活质量，尽管效应量较小。具备技术支持的交互式日记可以增加自我监测的频率并降低HbA水平。通过电话同步提供的远程护理使HbA有显著改善。
增加对技术的依赖所具有的成本效益灵活性是一个有吸引力的提议；然而，服务不足人群的数字连接存在资源问题。仍然需要更好地理解每个组成部分的哪些要素在特定背景下最有效，以及如何优化家庭、照顾者和同伴的影响和投入。
