Wang Lizhen, Li Jing, Zhang Minghui, Chan Maggie Mee Kie, Ho Mu-Hsing
School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR.
Department of Nephrology, Peking University First Hospital, Beijing, China.
Worldviews Evid Based Nurs. 2025 Jun;22(3):e70041. doi: 10.1111/wvn.70041.
Optimal glycemic control is known to be challenging for people with type 2 diabetes (T2D) due to the maintenance of long-term self-management behavior. Incorporating the transtheoretical model (TTM) components into motivational interviewing (MI) has been applied to promote self-management behaviors such as physical activity in T2D patients. However, the effectiveness of the TTM-based MI intervention in improving glycemic control, self-management, and self-efficacy in adults with T2D remains unclear.
This systematic review and meta-analysis of randomized controlled trials aimed to estimate the effect of a TTM-based MI intervention on glycemic control, self-management, and self-efficacy in adults with T2D patients.
We searched five electronic databases up to September 13, 2023. Two researchers independently screened records, extracted data, and assessed study quality using the Cochrane Risk of Bias Tool 2.0. Pooled effects were estimated in standardized mean differences (SMDs) or mean differences (MDs) using fixed- and random-effects models. Sensitivity analysis and meta-regression explored the reasons for heterogeneity.
Thirty trials with 4214 participants were identified. The TTM-based MI intervention significantly reduced HbA1c (MD = -0.92, 95% CI [-1.08, -0.75], p < 0.001, I = 65%), FPG (SMD = -1.06, 95% CI [-1.38, -0.73], p < 0.001, I = 93%), and 2hPG (MD = -1.42 mmol/L, 95% CI [-1.83, -1.00], p < 0.001, I = 89%), with high, moderate, and low certainty of evidence, respectively. The intervention also improved self-management (SMD = 1.47, 95% CI [1.16, 1.78], p < 0.001, I = 80%) and self-efficacy (SMD = 1.53, 95% CI [1.04, 2.02], p < 0.001, I = 92%). Meta-analysis revealed that MI treatment dose and initial glycemic status contributed to the high heterogeneity.
The TTM-based MI intervention can be a promising intervention for understanding patients' stage of change with tailored strategies and MI techniques to facilitate behavior change, resulting in improved glycemic control, self-management, and self-efficacy in T2D patients. Nevertheless, given the moderate to high risk of bias in the included studies, further rigorous randomized controlled trials should be conducted to examine the effectiveness of TTM-based MI interventions. Short and multiple sessions that comply with the fidelity of MI in the intervention plans are suggested in daily nursing routine for diabetes self-management education.
由于需要长期保持自我管理行为，最佳血糖控制对2型糖尿病（T2D）患者而言具有挑战性。将跨理论模型（TTM）的组成部分纳入动机性访谈（MI）已被用于促进T2D患者的自我管理行为，如体育锻炼。然而，基于TTM的MI干预对改善成年T2D患者的血糖控制、自我管理和自我效能的有效性仍不明确。
本项对随机对照试验的系统评价和荟萃分析旨在评估基于TTM的MI干预对成年T2D患者的血糖控制、自我管理和自我效能的影响。
我们检索了截至2023年9月13日的五个电子数据库。两名研究人员独立筛选记录、提取数据，并使用Cochrane偏倚风险工具2.0评估研究质量。使用固定效应模型和随机效应模型，以标准化均数差（SMD）或均数差（MD）估计合并效应。敏感性分析和Meta回归探讨了异质性的原因。
共纳入30项试验，4214名参与者。基于TTM的MI干预显著降低了糖化血红蛋白（MD = -0.92，95%CI [-1.08，-0.75]，p < 0.001，I² = 65%）、空腹血糖（SMD = -1.06，95%CI [-1.38，-0.73]，p < 0.001，I² = 93%）和餐后2小时血糖（MD = -1.42 mmol/L，95%CI [-1.83，-1.00]，p < 0.001，I² = 89%），证据确定性分别为高、中、低。该干预还改善了自我管理（SMD = 1.47，95%CI [1.16，1.78]，p < 0.001，I² = 80%）和自我效能（SMD = 1.53，95%CI [1.04，2.02]，p < 0.001，I² = 92%）。Meta分析显示，MI治疗剂量和初始血糖状态导致了高度异质性。
基于TTM的MI干预可能是一种有前景的干预措施，可通过量身定制的策略和MI技术了解患者的行为改变阶段，以促进行为改变，从而改善T2D患者的血糖控制、自我管理和自我效能。然而，鉴于纳入研究存在中度至高度偏倚风险，应开展进一步严格的随机对照试验，以检验基于TTM的MI干预的有效性。建议在糖尿病自我管理教育的日常护理中，采用简短且多次的干预方案，并在干预计划中遵循MI的保真度。
