Hailey R. Donnelly, Clare E. Collins, Erin D. Clarke, Prudence I. Morrissey, Natalie Gilbertson-Viljevac, Lucy Leigh, Peta E. Tehan
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引用次数: 0
摘要
背景：优化糖尿病患者的营养状况对于优化血糖控制，以及预防和促进伤口愈合至关重要。有多种营养干预措施可供选择。本系统综述和荟萃分析旨在描述和综合营养干预对糖尿病患者慢性伤口的预防和管理的有效性。方法：检索5个数据库和4个临床试验注册中心的营养干预研究。纳入的研究涉及营养干预，例如针对糖尿病和慢性伤口患者的个性化医疗营养治疗、教育和/或营养补充。利用随访时的平均伤口大小和可用的非调整数据完成meta分析。采用rob2和ROBINS评价质量，采用GRADE评价证据的确定性。结果：纳入23项研究；所有纳入的研究都是在糖尿病相关的足溃疡人群中进行的。meta分析显示，营养补充剂，包括单一和多种营养补充剂，可显著减少伤口深度（MWD -0.200 [95% CI -0.364, -0.035], p = 0.0172）、宽度（WMD -0.466 [95% CI -0.724, -0.208], p = 0.0004）和长度（-0.443 [95% CI -0.841, -0.045], p = 0.0292），纳入的研究质量较低，证据的确定性很低。虽然检测到大量异质性（I2 = 56%-68%），但进行了随机效应荟萃分析，以解释研究之间的变异性，在承认研究特征差异的同时提供总体估计。两项评估营养教育效果的研究显示，伤口大小显著减少（n = 1），治愈人数显著增加（n = 1）。结论：营养补充促进创面愈合的证据质量不高。营养教育可能有促进伤口缩小的作用。需要使用可靠的方法进行进一步的研究，以全面确定营养干预对伤口愈合的有效性。
Effectiveness of dietary interventions in individuals with diabetes for preventing and healing chronic wounds; a systematic review with meta-analysis
Background
Optimising the nutritional status of individuals with diabetes is essential to optimise glycaemic control, as well as to prevent and promote wound healing. A variety of nutrition interventions are available. This systematic review and meta-analysis aimed to describe and synthesise the effectiveness of nutrition interventions for the prevention and management of chronic wounds in people with diabetes.
Methods
Five databases and four clinical trial registries were searched for nutrition intervention studies. Included studies involved a nutrition intervention, such as personalised medical nutrition therapy, education and/or nutrient supplementation for those with diabetes and a chronic wound. Meta-analysis was completed utilising mean wound size at follow-up and non-adjusted data where available. Quality was appraised using RoB 2 and ROBINS, and certainty of evidence was assessed using GRADE.
Results
Twenty-three studies were included; all included studies were in diabetes-related foot ulcer populations. Meta-analyses demonstrated nutrient supplements, including single and multi-nutrient supplements, significantly reduced wound depth (MWD −0.200 [95% CI −0.364, −0.035], p = 0.0172), width (WMD −0.466 [95% CI −0.724, −0.208], p = 0.0004) and length (−0.443 [95% CI −0.841, −0.045], p = 0.0292), the quality of included studies was low and the certainty of evidence was very low. While substantial heterogeneity was detected (I2 = 56%–68%), a random-effects meta-analysis was conducted to account for between-study variability, providing an overall estimate while acknowledging differences in study characteristics. Two studies evaluating the effect of nutrition education demonstrated significant wound size reduction (n = 1) and proportion of people healed (n = 1).
Conclusion
There is low-quality evidence that nutrient supplementation improves wound healing. Nutrition education may have a role in enhancing wound size reduction. Further studies are needed using robust methodologies to comprehensively determine the effectiveness of nutrition interventions for wound healing.
期刊介绍：
Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions.
The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed.
We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services.
Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”
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