对护理门诊2型糖尿病患者治疗效果的系统评价

Therapeutic effect of nurse-led clinics in patients with T2DM：a systematic review

目的：评价护理门诊对2型糖尿病患者治疗效果的影响。方法计算机检索PubMed、EMBASE、Web of Science、CENTRAL、CBM、CNKI、VIP、Wanfang等中英文数据库中关于护理门诊对2型糖尿病患者治疗效果的随机对照试验（ RCT ）,检索时间从建库至2016年6月。根据Cochrane Handbook 5．1.0版推荐的“偏倚风险评估”工具对纳入的研究进行方法学质量评价,提取数据后采用RevMan 5.1软件进行Meta分析或仅进行描述性分析。结果共纳入15项RCT,2204例患者,Meta分析结果显示：与对照组相比,护理门诊干预能进一步降低2型糖尿病患者 HbA1c 水平[ MD=-1.11,95%CI （-1.47,-0.75）,P〈0.001],改善患者的遵医用药行为[RR=1.28,95%CI（1.20,1.35）]、饮食控制行为[RR=1.68,95%CI（1.52,1.86）]、合理运动行为[RR=1.32,95%CI（1.22,1.43）]、血糖监测行为[RR=1.68,95%CI （1．30,2.17）],并提高患者的生活质量。 Meta回归提示护理门诊的干预疗效与患者HbA1c基线水平呈负相关（ r=-0.33,P〈0.05）。结论开展护理门诊能够改善2型糖尿病患者的治疗效果,提高治疗依从性及其生活质量。

Objective To evaluate the therapeutic effect of nurse-led clinics （ NLCs） in patients with type 2 diabetes mellitus （ T2DM） . Methods We searched randomized controlled trials （ RCTs） related to the therapeutic effect of patients with T2DM in PubMed, EMBASE, CENTRAL, Web of science, CBM, CNKI, VIP, and Wanfang databases from the beginning to June 2016. The methodological quality assessment was used to assess the included studies according to “bias risk assessment” recommended by Cochrane Handbook 5. 1. 0 software, and the data were extracted and analyzed by using the RevMan 5.1 software. Results Totally 15 RCTs with 2 204 patients were included in this study. The Meta-analysis showed that：compared with the control group, NLC intervention can further decrease the HbA1c level of patients with T2DM [ MD=-1.11, 95%CI（-1.47,-0.75）, P〈0.001];improve patients′adherence to medication [RR=1.28, 95%CI（1.20,1.35）], diet control [RR=1.68, 95%CI（1.52,1.86）], exercise reinforcement [RR=1.32, 95%CI（1.22,1.43）], and regular blood glucose monitoring [ RR=1. 68, 95%CI （ 1. 30, 2. 17 ） ]; and improve patients′ quality of life. Meta-regression analysis showed that the effect of NLC were positively related to the baseline level of HbA1c （ r=-0.33, P〈0.05）. Conclusions The application of NLC can improve the therapeutic effect of patients with T2DM, and improve their treatment compliance and quality of life.