同伴支持对降低糖尿病患者糖化血红蛋白效果的Meta分析

Effectiveness of peer support interventions for decreasing glycosylated hemoglobin in patients with diabetes mellitus:a meta-analysis

目的评价同伴支持模式对降低2型糖尿病患者糖化血红蛋白(HbA1C)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RevMan5.2软件进行数据分析。结果共纳入17项随机对照研究,Meta分析结果显示同伴支持能降低T2DM患者的HbA1c水平,合并效应具有统计学意义[WMD=-0.21,95%CI(-0.35,-0.08),P=0.002]。且短期同伴支持干预(3个月、6个月)能够显著降低T2DM患者的HbA1c水平(均P<0.05),然而干预时间延长(12个月、24个月)时,干预组与对照组在降低患者的HbA1c水平方面无明显差异(均P>0.05)。单一形式(电话随访或个人访视或小组讨论等)对患者进行同伴教育,干预组与对照组在降低患者的HbA1c水平方面无明显差异(均P>0.05);而采用多种形式联合(电话随访联合个人访视以及小组讨论等)能够明显降低患者的HbA1c水平(P<0.01)。结论同伴支持能够降低T2DM患者的HbA1c,且短期效果优于长期效果,多种形式联合比单一干预形式能更好地降低HbA1c。但是考虑到此次纳入文献的质量为中等,因此期待更多临床多中心、大样本随机对照试验的开展来验证该模式的效果。

Objective To evaluate the effectiveness of peer support for decreasing glycosylated hemoglobin（HbA1c）level in patients with type 2diabetes mellitus（T2DM）.Methods Randomized controlled trials（RCTs）that reported the effectiveness of a peer support intervention in patients with T2 DM were retrieved in several electronic databases.RevMan5.2software was used to analyze the data after quality assessment and data extraction.Results Seventeen RCTs were included.The result of meta-analysis showed peer support could decrease HbA1 cin patients with T2 DM,with a pooled WMD of-0.21（95%CI,-0.35to-0.08,P=0.002].Subgroup analysis indicated that a 3-month or 6-month intervention could significantly control HbA1c（P〈0.05 for both）,but the effect of 12-month or 24-month intervention was not obvious（P〉0.05 for both）.Single use of telephone follow-up,personal interview or group discussion had no significant impact on decreasing HbA1 c,whereas combining use of the above methods could achieve HbA1ccontrol（P〈0.01）.Conclusion Based on the available evidence,peer support interventions help reduce HbA1 clevel in patients with T2DM;the short-term effect is more obvious than the long-term effect;and combining use of intervention methods can achieve good glycemic control.Further peer support programs should be implemented within the context of high quality research projects wherever possible.