Cheng Zhen, Xiao Qingyu, Xu Yanfei, Tan Lianyi, Qu Weixiang, Shen Wenying, Luo Yu
Guantian Community Healthcare Center, Shenzhen Baoan Shiyan People's Hospital, No.11, Jixiang Road, Shiyan Street, Baoan District, Shenzhen, 518108, China.
Department of Blood Transfusion, Shenzhen Baoan Shiyan People's Hospital, Shenzhen, 518108, China.
BMC Health Serv Res. 2025 Apr 28;25(1):613. doi: 10.1186/s12913-025-12539-6.
To assess the effectiveness of community-home patient-centred care (PCC) in the self-management of type 2 diabetes using a systematic evaluation approach.
This systematic review and meta-analysis adhered to the PRISMA 2020 guideline. The PubMed, Excerpta Medica Database, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, Chinese Periodicals Full Text Database, CQVIP Chinese Journals Platform and Wanfang databases were searched between database inception and February 2025, with no language limit, using keywords related to type 2 diabetes, PCC and self-management. References of the included studies were reviewed, and citation tracking was used. Eligible studies were English or Chinese peer-reviewed randomised controlled trials (RCTs) involving patients with type 2 diabetes, with PCC applied in the trial group and routine care in the control group, focusing on self-management outcomes. Two reviewers independently screened and extracted data, resolving disagreements through a third reviewer. The Cochrane risk assessment tool was used to assess study quality, with Review Manager 5.3 software used to analyse data using mean difference (MD) and 95%CI via a random-effects model. Heterogeneity was tested, and sensitivity analysis and funnel plots were also used.
A total of 18 RCTs were included, including 6 Chinese and 12 English studies, with 1,893 patients with type 2 diabetes followed up in this study. Following intervention for at least 6 months, compared with routine treatment, PCC reduced fasting blood glucose (FBG) (MD = - 1.27, 95%CI: [- 2.19, - 0.74], I = 34%, fixed-effect model) and 2-hour postprandial blood glucose (2hPG) (MD = - 0.76, 95%CI: [- 1.23,-0.28], I = 81%, random-effects model), but there was no improvement in body mass index (BMI) (MD = - 0.59, 95%CI: [- 1.31, - 0.13], I = 0%, fixed-effect model) or foot care (MD = - 1.51, 95%CI: [- 2.17, - 5.19], I = 94%, random-effects model). After 3 months of intervention, compared with the routine treatment, PCC decreased glycosylated haemoglobin A1c (HbA1c) levels (MD = - 0.60, 95%CI: [- 0.88, - 0.32], I = 81%, random-effects model), but the BMI did not decrease significantly (MD = - 0.26, 95%CI: [- 1.46, - 0.93], I = 0%, fixed-effect model).
Compared with routine nursing, community-home PCC nursing can reduce the levels of FBG, 2-hour plasma glucose (2hPG) and glycated haemoglobin A1c (HbA1c) in patients with type 2 diabetes. A unified PCC protocol could help patients with diabetes control the disease.
采用系统评价方法评估社区居家以患者为中心的护理（PCC）在2型糖尿病自我管理中的有效性。
本系统评价和荟萃分析遵循PRISMA 2020指南。在数据库建立至2025年2月期间，对PubMed、医学文摘数据库、Cochrane图书馆、科学网、中国生物医学文献数据库、中国期刊全文数据库、维普中文期刊平台和万方数据库进行检索，不限语言，使用与2型糖尿病、PCC和自我管理相关的关键词。对纳入研究的参考文献进行回顾，并采用引文跟踪。纳入标准为英文或中文同行评审的随机对照试验（RCT），研究对象为2型糖尿病患者，试验组采用PCC，对照组采用常规护理，重点关注自我管理结果。两名评审员独立筛选和提取数据，通过第三名评审员解决分歧。采用Cochrane风险评估工具评估研究质量，使用Review Manager 5.3软件通过随机效应模型以均数差（MD）和95%置信区间（CI）分析数据。进行异质性检验，并采用敏感性分析和漏斗图。
共纳入18项RCT，其中中文研究6项，英文研究12项，本研究共随访了1893例2型糖尿病患者。干预至少6个月后，与常规治疗相比，PCC降低了空腹血糖（FBG）（MD = -1.27，95%CI：[-2.19，-0.74]，I² = 34%，固定效应模型）和餐后2小时血糖（2hPG）（MD = -0.76，95%CI：[-1.23，-0.28]，I² = 81%，随机效应模型），但体重指数（BMI）（MD = -0.59，95%CI：[-1.31，-0.13]，I² = 0%，固定效应模型）或足部护理（MD = -1.51，95%CI：[-2.17，-5.19]，I² = 94%，随机效应模型）无改善。干预3个月后，与常规治疗相比，PCC降低了糖化血红蛋白A1c（HbA1c）水平（MD = -0.60，95%CI：[-0.88，-0.32]，I² = 81%，随机效应模型），但BMI无显著下降（MD = -0.26，95%CI：[-1.46，-0.93]，I² = 0%，固定效应模型）。
与常规护理相比，社区居家PCC护理可降低2型糖尿病患者的FBG、餐后2小时血糖（2hPG）和糖化血红蛋白A1c（HbA1c）水平。统一的PCC方案有助于糖尿病患者控制病情。
