糖尿病自我管理计划对老年人临床和患者报告结果的影响:系统回顾和荟萃分析。

Frontiers in clinical diabetes and healthcare Pub Date : 2024-06-17 eCollection Date: 2024-01-01 DOI:10.3389/fcdhc.2024.1348104
Paige Alliston, Milos Jovkovic, Saira Khalid, Donna Fitzpatrick-Lewis, Muhammad Usman Ali, Diana Sherifali
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引用次数: 0

摘要

目标:随着老年人糖尿病自我管理变得越来越复杂,自我管理计划已被证明能够帮助这一人群满足多方面的医疗需求。在之前的系统综述和荟萃分析的基础上,我们旨在更新有关糖尿病自我管理计划有效性的文献,并研究特定的自我管理干预措施对临床和患者报告结果的影响:我们更新了在以下数据库中的文献检索:从 2013 年 11 月到 2023 年 7 月,我们更新了 Medline、EMBASE、PsychINFO、CINAHL 和 Cochrane 随机对照试验数据库中符合纳入标准的研究文献。两位独立审稿人筛选并提取了纳入研究的数据:共有 17 项研究的 21 个对比臂符合纳入标准,共计 5976 名老年人(3510 人随机接受自我管理方案,2466 人接受常规护理)。糖尿病自我管理计划对老年人血糖控制(血红蛋白 A1C)的综合疗效为-0.32(95% CI -0.44,-0.19)。具体来说,对血糖控制(A1C)最有效的方法是使用反馈(-0.52%;95% CI -0.68,-0.36)。总体而言,自我管理计划改善了行为改变结果,其中反馈干预最为有效(标准化平均差 [SMD] 0.91;95% CI 0.39,1.43)。自我管理计划对体重指数、体重和血脂的影响在统计学和临床上都有显著意义:针对老年人的糖尿病自我管理计划的证据表明,A1C 的降低幅度较小,但具有临床意义;患者报告的结果(行为、自我效能、知识)和其他临床结果(体重指数、体重和血脂)均有所改善。为取得最佳疗效,应考虑在老年人糖尿病自我管理计划中使用的具体策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The effects of diabetes self-management programs on clinical and patient reported outcomes in older adults: a systematic review and meta-analysis.

Objectives: With diabetes self-management continuing to become more complex for older adults, self-management programs have been shown to support this population in meeting their multifaceted medical needs. Building on our previous systematic review and meta-analysis, we aimed to update the literature on the effectiveness of diabetes self-management programs and investigate the impact of specific self-management interventions on clinical and patient-reported outcomes.

Methods: We updated our literature search in the following databases: Medline, EMBASE, PsychINFO, CINAHL and Cochrane Database of Randomized Controlled Trials from November 2013 to July 2023 for studies that may fit our inclusion criteria. Two independent reviewers screened and extracted data from the included group of studies.

Results: A total of 17 studies with 21 comparison arms met the inclusion criteria, totalling 5976 older adults (3510 individuals randomized to self-management programming and 2466 to usual care). The pooled effectiveness of diabetes self-management programs in older adults on glycemic control (hemoglobin A1C) was a reduction of -0.32 (95% CI -0.44, -0.19). Specifically, the most effective approach on glycemic control (A1C) was the use of feedback (-0.52%; 95% CI -0.68, -0.36). Overall, self-management programs improved behaviour change outcomes, with feedback interventions being most effective (standardized mean difference [SMD] 0.91; 95% CI 0.39, 1.43). The effect of self-management programs on body mass index, weight and lipids were statistically and clinically significant.

Conclusions: The evidence for diabetes self-management programs for older adults demonstrates a small but clinically meaningful reduction in A1C, improvement in patient-reported outcomes (behaviour, self-efficacy, knowledge), and other clinical outcomes (BMI, weight and lipids). The specific strategy used in diabetes self-management programs for older adults should be considered to achieve optimal results on outcomes.

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