正念减压疗法对改善糖尿病患者心理困扰和血糖的系统评价

Effectiveness of mindfulness-based stress reduction on psychological distress and glycemic control in patients with diabetes: A systematic review

目的系统评价正念减压疗法对糖尿病患者心理困扰和血糖的干预效果。方法计算机检索Pubmed、Cochranelibrary、Embase、Webofscience、知网、万方、维普和中国生物医学文献数据库,查找有关正念减压疗法干预糖尿病患者的随机对照试验,按照纳排标准对文献质量评价后,采用RevMan5.3进行Meta分析。结果共纳入6个研究,372例患者。Meta分析结果显示:与对照组相比,正念减压疗法组在改善糖尿病患者中期焦虑情绪[SMD=-0.86,95%CI(-1.33,-0.38),P=0.0004]、中期压力[MD=-6.71,95%CI(-7.85,-5.57),P<0.0001]、长期压力[MD=-1.2,95%CI(-1.72,-0.68),P<0.0001]和血糖控制[MD=-3.0,95%CI(-0.45,-0.15),P<0.0001]方面差异有统计学意义,但对于改善短期焦虑、压力和血糖的效果不显著,对于改善相关情绪困扰、抑郁情绪的效果还不能确定。结论正念减压疗法能够有效缓解糖尿病患者中期焦虑情绪、对减轻压力、改善血糖控制有中长期效应,但对于减轻相关情绪困扰、抑郁情绪,改善短期内焦虑、压力和血糖的效果有待开展更多的研究加以验证。

Objective To evaluate the intervention effectiveness of mindfulness-based stress reduction (MBSR) on on psychological distress and blood sugar in patients with diabetes systematically. Methods Randomized clinical trials(RCTs) reporting the intervention of MBSR on patients with diabetes were retrieved from the PubMed,Cochrane Library,Embase,Web of science,CNKI,Wan Fang Data,VIP and CBM. We conducted Meta-analysis using RevMan 5.3 after assessing the quality of included studies according to the inclusion and exclusion criteria. Results 6 studies including 372 patients were included. The Meta-analysis results showed that compared with the control group, MBSR had significant differences in improving mid-term anxiety[ SMD =-0.86,95% CI (-1.33,-0.38), P =0.000 4], mid-and long-term stress[MD=-6.71,95% CI (-7.85,-5.57), P <0.000 1][ MD =-1.2,95% CI (-1.72,-0.68 ), P < 0.000 1] and glycemic control[ MD =-3.0,95% CI (-0.45,-0.15), P <0.000 1] in diabetic patients. But the difference of diabetes-related emotional distress and depression is still uncertain. Conclusion The present evidences show that the MBSR can effectively alleviate the mid-term anxiety and have a medium- and long-term effect on improving stress and glycemic control for diabetic patients, but the effectiveness of improving diabetes- related emotional distress, depression, short-term anxiety, stress and glycemic control still needs further studies to verify.