综合护理方法对共病抑郁和糖尿病影响的系统评价和荟萃分析。

Effects of Integrated Care Approaches to Address Co-occurring Depression and Diabetes: A Systematic Review and Meta-analysis.

机构信息

University of Georgia School of Social Work, Athens, GA.

Department of Family and Preventative Medicine, School of Medicine, Emory University, Atlanta, GA.

出版信息

Diabetes Care. 2024 Dec 1;47(12):2291-2304. doi: 10.2337/dc24-1334.

DOI:10.2337/dc24-1334

PMID:39602589

Abstract

BACKGROUND

Depressive symptoms frequently co-occur with diabetes and, when unaddressed, can function to worsen diabetes control and increase the risk of diabetes-related morbidity. Integrated care (IC) approaches aim to improve outcomes among people with diabetes and depression, but there are no current meta-analyses examining their effects.

PURPOSE

In our study we summarize the effects of IC approaches to address depression and diabetes and examine moderating effects of IC approaches (e.g., behavioral intervention used; type of IC approach).

DATA SOURCES

A systematic search was conducted of PubMed, PsycInfo, CINAHL, and ProQuest.

STUDY SELECTION

Two reviewers triaged abstracts and full-text articles to identify relevant articles. Randomized controlled trials with enrollment of participants with diabetes and depressive symptoms and with provision of sufficient data on depression scores and hemoglobin A1c were included.

DATA EXTRACTION

Two reviewers extracted demographic information, depression scores, diabetes outcomes, intervention details, and the risk of bias for each study.

DATA SYNTHESIS

From 517 abstracts, 75 full-text reports were reviewed and 31 studies with 8,843 participants were analyzed. Among 26 studies with reporting of HbA1c, IC approaches were associated with a significant between-group difference regarding the percent decrease of HbA1c (d = -0.36, 95% CI -0.52 to -0.21). Studies that included a combination of behavioral interventions (behavioral activation with cognitive behavioral therapy) showed greater reductions in HbA1c. Among 23 studies with reporting of depressive symptoms, the pooled effect of IC approaches lowered depressive scores by 0.72 points (95% CI -1.15 to -0.28).

LIMITATIONS

The inclusion of a wide range of IC approaches increased study heterogeneity. A random effects model and sensitivity analyses mitigated this limitation.

CONCLUSIONS

IC approaches are associated with improved glycemia and depressive symptoms in comparison with treatment as usual.

摘要

背景

抑郁症状常与糖尿病同时发生，如得不到解决，可能会使糖尿病控制恶化，并增加与糖尿病相关的发病率。综合护理（IC）方法旨在改善糖尿病和抑郁症患者的预后，但目前尚无荟萃分析检查其效果。

目的

在我们的研究中，我们总结了针对抑郁和糖尿病的 IC 方法的效果，并检查了 IC 方法（例如，使用的行为干预；IC 方法的类型）的调节作用。

数据来源

对 PubMed、PsycInfo、CINAHL 和 ProQuest 进行了系统检索。

研究选择

两位审查员对摘要和全文文章进行了分类，以确定相关文章。纳入了有糖尿病和抑郁症状患者参与、提供足够的抑郁评分和血红蛋白 A1c 数据的随机对照试验。

数据提取

两位审查员提取了人口统计学信息、抑郁评分、糖尿病结果、干预细节以及每项研究的偏倚风险。

数据综合

从 517 篇摘要中，有 75 篇全文报告进行了审查，对 31 项研究（8843 名参与者）进行了分析。在 26 项报告 HbA1c 的研究中，IC 方法与 HbA1c 的组间差异显著（d=-0.36，95%CI-0.52 至-0.21）。包括行为干预（行为激活与认知行为疗法）组合的研究显示 HbA1c 降低幅度更大。在 23 项报告抑郁症状的研究中，IC 方法的综合效果使抑郁评分降低了 0.72 分（95%CI-1.15 至-0.28）。