有组织的血糖自我监测对非胰岛素治疗的2型糖尿病患者的临床、行为和社会心理结局的影响:一项系统回顾和荟萃分析

Elizabeth Holmes-Truscott, Shaira Baptista, Mathew Ling, Eileen Collins, EIif I Ekinci, John Furler, Virginia Hagger, Jo-Anne Manski-Nankervis, Caroline Wells, Jane Speight
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引用次数: 0

摘要

背景:自我血糖监测(SMBG)被认为对非胰岛素治疗的成人2型糖尿病患者没有什么临床益处,但迄今为止尚未发表关于SMBG结构化方法的全面综述。目的:对sSMBG对HbA1c、治疗修改、行为和社会心理结局的影响进行系统回顾和荟萃分析;检查sSMBG协议特征对HbA1c的调节作用。数据来源:检索到4个数据库(2020年11月;更新日期:2022年2月)。研究选择:纳入标准:非随机对照试验和随机对照试验(rct)以及前瞻性观察性研究;报告sSMBG对既定结果的影响;非胰岛素治疗的2型糖尿病成人(≥18岁)。研究排除了儿童或胰岛素治疗或其他形式的糖尿病患者。数据提取和分析:结果数据提取,偏倚风险/质量由两名研究人员独立评估。对随机对照试验进行了荟萃分析,并探讨了调节因子(仅HbA1c)。数据综合:从2078篇摘要中,纳入了k=23项研究(N= 5372)。偏倚风险明显,研究质量较低。评估的结果包括:糖化血红蛋白(k=23),治疗改变(k=16),社会心理/行为结果(k=12)。荟萃分析显示,sSMBG在HbA1c (- 0.29%, 95% CI: - 0.46至- 0.11,k=13)和糖尿病自我效能(0.17%,95% CI: 0.01至0.33,k=2)方面的平均差异显著。meta分析显示,协议特征没有显著的调节作用。局限性:研究设计、干预特征和社会心理评估的异质性限制了研究结果。结论:sSMBG对HbA1c和糖尿病自我效能感有较小的正向作用。对sSMBG干预特征的叙述性综合可以指导未来的实施。普洛斯彼罗注册:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020208857,标识符CRD42020208857。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

The impact of structured self-monitoring of blood glucose on clinical, behavioral, and psychosocial outcomes among adults with non-insulin-treated type 2 diabetes: a systematic review and meta-analysis.

The impact of structured self-monitoring of blood glucose on clinical, behavioral, and psychosocial outcomes among adults with non-insulin-treated type 2 diabetes: a systematic review and meta-analysis.

The impact of structured self-monitoring of blood glucose on clinical, behavioral, and psychosocial outcomes among adults with non-insulin-treated type 2 diabetes: a systematic review and meta-analysis.

Background: Self-monitoring of blood glucose (SMBG) is considered of little clinical benefit for adults with non-insulin-treated type 2 diabetes, but no comprehensive review of a structured approach to SMBG has been published to date.

Purpose: To conduct a systematic review and meta-analysis of the impact of sSMBG on HbA1c, treatment modifications, behavioral and psychosocial outcomes, and; examine the moderating effects of sSMBG protocol characteristics on HbA1c.

Data sources: Four databases searched (November 2020; updated: February 2022).

Study selection: Inclusion criteria: non-randomized and randomized controlled trials (RCTs) and prospective observational studies; reporting effect of sSMBG on stated outcomes; among adults (≥18 years) with non-insulin-treated type 2 diabetes. Studies excluded if involving children or people with insulin-treated or other forms of diabetes.

Data extraction and analysis: Outcome data extracted, and risk of bias/quality assessed independently by two researchers. Meta-analysis was conducted for RCTs, and moderators explored (HbA1c only).

Data synthesis: From 2,078 abstracts, k=23 studies were included (N=5,372). Risk of bias was evident and study quality was low. Outcomes assessed included: HbA1c (k=23), treatment modification (k=16), psychosocial/behavioral outcomes (k=12). Meta-analysis revealed a significant mean difference favoring sSMBG in HbA1c (-0·29%, 95% CI: -0·46 to -0·11, k=13) and diabetes self-efficacy (0.17%, 95% CI: 0.01 to 0.33, k=2). Meta-analysis revealed no significant moderating effects by protocol characteristics.

Limitations: Findings limited by heterogeneity in study designs, intervention characteristics, and psychosocial assessments.

Conclusion: A small positive effect of sSMBG on HbA1c and diabetes self-efficacy was observed. Narrative synthesis of sSMBG intervention characteristics may guide future implementation.

Prospero registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020208857, identifier CRD42020208857.

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