Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand.
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
Diabetes Metab Res Rev. 2024 Sep;40(6):e3840. doi: 10.1002/dmrr.3840.
This systematic review and network meta-analysis compared the effects of various diabetes self-management programs: Diabetes Self-Management Education (DSME), Diabetes Self-Management Support (DSMS), and Diabetes Self-Management Education and Support (DSMES).
We searched four electronic databases for eligible articles up to March 1, 2023. Only randomized controlled trials investigating the effects of DSME, DSMS, or DSMES on glycated haemoglobin (HbA1c) level, fasting blood glucose (FBG), total cholesterol (TC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) in adults with type 2 diabetes were included. Cochrane Risk of Bias 2.0 tool was used to assess each study quality, and Confidence in Network Meta-Analysis was applied to evaluate the certainty of the evidence. Data were pooled with a random-effects model under a frequentist framework.
A total of 108 studies encompassing 17,735 participants (mean age 57.4 years) were analysed. DSMES, compared with usual care, significantly reduced HbA1c level (mean difference = -0.61%, 95% confidence interval [CI] = -0.74 to -0.49; certainty of evidence = moderate), FBG (-23.33 mg/dL; -31.33 to -15.34; high), TC (-5.62 mg/dL; -8.69 to -2.55; high), SBP (-3.05 mmHg; -5.20 to -0.91; high), and DBP (-2.15 mmHg; -3.36 to -0.95; high). Compared with DSME, DSMES showed significantly greater improvements in HbA1c levels (-0.23%; -0.40 to -0.07; high) and DBP (-1.82 mmHg; -3.47 to -0.17; high). DSMES was ranked as the top treatment for improving diabetes clinical outcomes (0.82-0.97) in people with type 2 diabetes.
DSMES, in people with type 2 diabetes, yields the greatest improvement in the key clinical outcomes of HbA1c, fasting blood glucose, and blood pressure levels. Healthcare providers should incorporate the DSMES approach into their daily care routines. Approximately 30% of the studies reviewed raised some concerns about their quality, underscoring the need for high-quality studies in this area.
本系统评价和网络荟萃分析比较了各种糖尿病自我管理计划的效果：糖尿病自我管理教育（DSME）、糖尿病自我管理支持（DSMS）和糖尿病自我管理教育和支持（DSMES）。
我们检索了截至 2023 年 3 月 1 日的四个电子数据库中符合条件的文章。仅纳入了评估 DSME、DSMS 或 DSMES 对 2 型糖尿病成人糖化血红蛋白（HbA1c）水平、空腹血糖（FBG）、总胆固醇（TC）、收缩压（SBP）和舒张压（DBP）影响的随机对照试验。使用 Cochrane 偏倚风险 2.0 工具评估每项研究的质量，并应用网络荟萃分析置信度评估证据的确定性。数据采用随机效应模型在概率框架下进行合并。
共分析了 108 项研究，包含 17735 名参与者（平均年龄 57.4 岁）。与常规护理相比，DSMES 显著降低了 HbA1c 水平（平均差值=-0.61%，95%置信区间[CI]：-0.74 至 -0.49；证据确定性为中等）、FBG（-23.33mg/dL；-31.33 至 -15.34；高）、TC（-5.62mg/dL；-8.69 至 -2.55；高）、SBP（-3.05mmHg；-5.20 至 -0.91；高）和 DBP（-2.15mmHg；-3.36 至 -0.95；高）。与 DSME 相比，DSMES 在 HbA1c 水平（-0.23%；-0.40 至 -0.07；高）和 DBP（-1.82mmHg；-3.47 至 -0.17；高）方面的改善更为显著。DSMES 在改善 2 型糖尿病患者的糖尿病临床结局方面排名最高（0.82-0.97）。
在 2 型糖尿病患者中，DSMES 可最大程度地改善 HbA1c、空腹血糖和血压水平等关键临床结局。医疗保健提供者应将 DSMES 方法纳入其日常护理常规。约 30%的综述研究对其质量提出了一些担忧，这突显了该领域高质量研究的必要性。
