School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
School of Pharmacy and Pharmaceutical Sciences, Monash University - Parkville Campus, Parkville, Victoria, Australia.
BMJ Open Diabetes Res Care. 2023 Feb;11(1). doi: 10.1136/bmjdrc-2022-003203.
The prevalence of pre-diabetes is increasing globally, affecting an estimated 552 million people by 2030. While lifestyle interventions are the first line of defense against progression toward diabetes, information on barriers toward pre-diabetes management and how to overcome these barriers are scarce. This systematic review describes the publics' and healthcare professionals' knowledge, attitude and practice (KAP) toward pre-diabetes and determines the barriers toward pre-diabetes management. A systematic search for studies examining KAP towards pre-diabetes was conducted in six databases from inception to September 2022. Studies that quantitatively assessed at least two KAP elements using questionnaires were included. The quality of studies was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Barriers and enablers were identified and mapped onto the Capability, Motivation, and Behaviour model to identify factors that influence behavior change. Twenty-one articles that surveyed 8876 participants were included in this review. Most of the reviews (n=13) were directed to healthcare professionals. Overall, positive attitudes toward diabetes prevention efforts were observed, although there were still knowledge deficits and poor behavior toward pre-diabetes management. Barriers and enablers were detected at patients (eg, goals and intention), healthcare professionals (eg, clinical judgement) and system (eg, access and resources) levels. The use of different survey instruments to assess KAP prevented a head-to-head comparison between studies. Most studies conducted among patients were from middle-income countries, while among healthcare professionals (HCPs) were from high-income countries, which may produce some biasness. Nevertheless, the development of pre-diabetes intervention should focus on: (1) increasing knowledge on pre-diabetes and its management; (2) imparting practical skills to manage pre-diabetes; (3) providing resources for lifestyle management; (4) improving the accessibility of lifestyle management programs; and (5) other HCPs and human support to pre-diabetes management.
全球范围内，前驱糖尿病的患病率正在上升，预计到 2030 年，前驱糖尿病患者将达到 5.52 亿。虽然生活方式干预是预防糖尿病进展的第一道防线，但有关前驱糖尿病管理障碍以及如何克服这些障碍的信息却很少。本系统综述描述了公众和医疗保健专业人员对前驱糖尿病的知识、态度和实践（KAP），并确定了前驱糖尿病管理的障碍。从研究开始到 2022 年 9 月，在六个数据库中系统地搜索了评估前驱糖尿病 KAP 的研究。使用问卷评估至少两个 KAP 要素的研究被纳入。使用 NIH 观察性队列和横断面研究质量评估工具评估研究质量。确定了障碍和促进因素，并将其映射到能力、动机和行为模型上，以确定影响行为改变的因素。本综述纳入了 21 篇调查了 8876 名参与者的文章。大多数综述（n=13）针对医疗保健专业人员。总的来说，观察到了对糖尿病预防工作的积极态度，尽管仍然存在知识不足和对前驱糖尿病管理的不良行为。在患者（如目标和意图）、医疗保健专业人员（如临床判断）和系统（如获取途径和资源）层面都发现了障碍和促进因素。使用不同的调查工具来评估 KAP 妨碍了对研究的直接比较。大多数针对患者进行的研究来自中等收入国家，而针对医疗保健专业人员（HCPs）的研究来自高收入国家，这可能会产生一些偏差。然而，前驱糖尿病干预措施的制定应侧重于：（1）增加对前驱糖尿病及其管理的认识；（2）传授管理前驱糖尿病的实用技能；（3）提供生活方式管理资源；（4）改善生活方式管理计划的可及性；（5）其他 HCP 和人力支持前驱糖尿病管理。
