强化糖尿病教育与常规糖尿病教育比较预防糖尿病足溃疡的系统评价

Intensive versus Routine Education on Diabetes Mellitus for Preventing Diabetic Foot Ulcer:A Systematic Review

目的 系统评价强化糖尿病教育与常规糖尿病教育比较预防糖尿病足溃疡的有效性。方法 计算机检索CENTRAL（2013年第1期）、PubMed（1978～2013）、EMbase（1978～2013）、VIP（1989～2013）和WanFang Data（1980～2013），同时手工检索相关会议论文集并追溯纳入文献的参考文献，全面收集全世界关于强化糖尿病教育与常规糖尿病教育比较预防糖尿病足溃疡的随机对照试验。由2位研究者独立按照纳入与排除标准筛选文献、提取资料和评价质量后，采用RevMan 5.2进行Meta分析。结果 最终纳入12个研究，1 841例患者。Meta分析结果显示：强化糖尿病教育组糖尿病足溃疡发生率低于常规糖尿病教育组，其差异有统计学意义［RR=0.51，95%CI（0.30，0.84），P=0.008］；但两组糖尿病足截肢率差异无统计学意义［OR=0.54，95%CI（0.17，1.67），P=0.28］；强化糖尿病教育组糖尿病知识积分高于常规糖尿病教育组，其差异有统计学意义［MD=7.32，95%CI （3.57，11.06），P=0.000 1］。结论 现有证据表明：强化糖尿病教育较常规糖尿病教育能更有效地减少糖尿病足溃疡的发生率，但上述结论尚需开展更多高质量的研究加以验证。

Objective To assess the effectiveness of intensive versus routine education on diabetes mellitus for preventing diabetic foot ulcer. Methods We electronically searched CENTRAL （Issue 1, 2013）, PubMed （1978-2013）, EMbase （1978-2013）, VIP （1989-2013） and WanFang Data （1980-2013）, hand-searched correlated proceedings and retrieved the references of included studies, for the randomized controlled trials on intensive versus routine education on diabetes mellitus for preventing diabetic foot ulcer all over the world. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results Twelve trials involving 1 841 patients were finally included. The results of meta-analysis showed that： a） the incidence of diabetic foot ulcer in the intensive education group was lower than the routine group, with a significant difference （RR=0.51, 95%CI 0.30 to 0.84, P=0.008）; b） two groups were alike in the amputation rate, with no significant difference （OR=0.54, 95%CI 0.17 to 1.67, P=0.28）; and c） the score of knowledge on diabetes mellitus was higher in the intensive education group than in the routine education group, with a significant difference （MD=7.32, 95%CI 3.57 to 11.06, P=0.000 1）. Conclusion Current evidence shows that： compared with routine education, intensive education could reduce the incidence of diabetic foot ulcer effectively. However, the above conclusion should be verified by conducting more high quality studies.