Vanessa M Menezes, Olívia G Koller, Ana Maria P Feoli, Flávia M Silva, Jussara C Almeida
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引用次数: 0
Abstract
Context: The pillars of diabetes treatment include pharmacotherapy, healthy eating, physical activity, self-monitoring, education, mental health support, and smoking cessation. Interventions based on the Transtheoretical Model of Change, which consider a patient's readiness to behavioral change, may be effective for promoting sustainable self-care. However, the impact of such interventions on diabetes management requires systematic evaluation.
Objective: To systematically review the effect of diet and/or exercise interventions based on the Transtheoretical Model of Change on glycemic control, body weight, and glucose-lowering medication medications in adults with type 2 diabetes.
Data sources: PubMed, Web of Science, Embase, Scopus, and PsycInfo were searched through June 2024. Randomized controlled trials (RCTs) with adults having type 2 diabetes were included; those involving pregnant or lactating women were excluded.
Data extraction: Studies were selected based on (P) individuals with type 2 diabetes, (I) diet and/or exercise interventions based on Transtheoretical Model of Change, (C) usual care, and (O) glycated hemoglobin, fasting glucose, body weight, body mass index, and medication dosage. Two reviewers independently screened RCTs, extracted data, and assessed quality using the Cochrane Risk of Bias tool.
Data analysis: Twelve RCTs (n = 2484) were included. Two studies involved dietary strategies only, 4 involved exercise interventions only, and 6 involved multicomponent interventions. Interventions based on the Transtheoretical Model of Change reduced glycated hemoglobin by 0.73% (n = 11 RCTs, 1.292 participants; 95% CI, -1.10 to -0.36; I2 = 75%) compared to usual care. Egger's test (P = .43) suggested no publication bias, but evidence certainty was very low. Meta-analysis of body weight and medication use was not feasible because of limited data.
Conclusion: Interventions based on the Transtheoretical Model of Change had a positive effect on glycemic control in adults with type 2 diabetes, but evidence was limited by methodological concerns, highlighting the need for well-designed future trials.
背景：糖尿病治疗的支柱包括药物治疗、健康饮食、体育活动、自我监控、教育、心理健康支持和戒烟。基于改变的跨理论模型的干预，考虑病人对行为改变的准备，可能对促进可持续的自我保健有效。然而，这些干预措施对糖尿病管理的影响需要系统的评估。目的：系统回顾基于跨理论变化模型的饮食和/或运动干预对成人2型糖尿病患者血糖控制、体重和降糖药物治疗的影响。数据来源：PubMed， Web of Science, Embase， Scopus和PsycInfo检索截止到2024年6月。纳入了成人2型糖尿病患者的随机对照试验（RCTs）；涉及孕妇或哺乳期妇女的研究被排除在外。数据提取：研究选择基于(P) 2型糖尿病患者，(I)基于Transtheoretical Model of Change的饮食和/或运动干预，(C)常规护理，(O)糖化血红蛋白、空腹血糖、体重、体重指数和药物剂量。两位审稿人独立筛选rct，提取数据，并使用Cochrane偏倚风险工具评估质量。资料分析：纳入12项rct （n = 2484）。两项研究仅涉及饮食策略，4项研究仅涉及运动干预，6项研究涉及多组分干预。与常规治疗相比，基于Transtheoretical Model of Change的干预使糖化血红蛋白降低了0.73% （n = 11 RCTs， 1.292名受试者；95% CI, -1.10至-0.36;I2 = 75%）。Egger检验（P = .43）提示无发表偏倚，但证据确定性非常低。由于数据有限，体重和药物使用的meta分析是不可行的。结论：基于Transtheoretical Model of Change的干预措施对成人2型糖尿病患者的血糖控制有积极作用，但由于方法学方面的考虑，证据有限，因此需要进行精心设计的未来试验。系统评审注册：普洛斯彼罗注册号。CRD42022301516。
期刊介绍：
Nutrition Reviews is a highly cited, monthly, international, peer-reviewed journal that specializes in the publication of authoritative and critical literature reviews on current and emerging topics in nutrition science, food science, clinical nutrition, and nutrition policy. Readers of Nutrition Reviews include nutrition scientists, biomedical researchers, clinical and dietetic practitioners, and advanced students of nutrition.
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