同伴支持教育对2型糖尿病患者自我管理效果的Meta分析

Effectiveness of peer support for improving self-management in patients with type 2 diabetes: a Meta-analysis of randomized controlled trials

目的评价同伴支持教育模式对2型糖尿病(type 2 diabetes mellitus,T2DM)患者自我管理效果的影响。方法计算机检索多个中英文数据库,搜集符合纳入排除标准的随机对照试验,进行文献质量评价后,采用Rev Man5.2进行数据分析。结果此次研究共纳入13篇随机对照试验(randomized controlled trial,RCT),Meta分析结果显示:同伴支持较常规干预降低了T2DM患者的糖化血红蛋白,合并效应具有统计学意义[WMD=-0.11,95%CI(-0.20^-0.02),P=0.02];提高了患者的糖尿病知识水平,合并效应具有统计学意义[WMD=0.90,95%CI(0.44~1.36),P<0.01];改善了患者的心理健康状态,合并效应具有统计学意义[WMD=1.73,95%CI(0.20~3.26),P=0.03]。然而,同伴支持在降低T2DM患者体质指数、总胆固醇与低密度脂蛋白水平,提高自我效能、社会健康状态方面无明显作用,合并效应不具有统计学意义(P>0.05)。此外,对于同伴支持能否提高患者的自我管理能力尚缺乏有力证据。结论同伴支持能够降低T2DM患者的糖化血红蛋白,提高糖尿病知识水平,改善心理健康状态;而对改善体质指数、总胆固醇、低密度脂蛋白、自我效能、社会健康状态方面则并无明显作用,在提高患者自我管理能力方面缺乏有力证据,期待更多临床多中心、大样本RCT的开展。

Objective To evaluate the effectiveness of peer support for improving self-management in patients with type 2 diabetes mellitus（T2DM）. Methods Randomized clinical trials（RCTs） that assessed the effectiveness of peer support in patients with T2DM were selected in muhiple electronic databases. RevManS.2 software was used to analyze the data after quality assessment,and data extraction were made for eligible RCTs. Results A total of 13 RCTs were included. The results of recta-analysis supported the effectiveness of peer support on reducing glyco- sylated hemoglobin （HbAlc） in patients with T2DM [WMD=-0.11,95%CI（-0.20,-0.02）,P=0.02],as well as the effectiveness on improving diabetes knowlcdge[WMD=0.90,95%CI（0.44,1.36）,P=0.0001]and mental health status [WMD=1.73,95%CI （0.20,3.26）,P=0.03]. While it was unclear that if peer support could improve the ability of self-management and it failed to support the effectiveness on reducing body mass index （BMI）,total cholesterol, LDL cholesterol and improving self-efficacy and social health status. Conclusion Peer support is effective to reduce HbAlc,improve diabetes knowledge and mental health status in patients with T2DM. While it could not effectively reduce BMI,total cholesterol,LDL cholesterol and improve self-efficacy,social health status. Due to the factth at effectiveness on improving the ability of self-management is still not certain,multi-centered randomized controlled trials with large sample size are needed in the future to confirm the effectiveness of peer support.