跨理论模型健康教育对2型糖尿病患者自我管理效果的Meta分析

Effectiveness of transtheoretical model-based health education for glycaemic control in patients with type 2 diabetes: a Meta-analysis

目的评价基于跨理论模型健康教育对2型糖尿病患者自我管理的效果。方法计算机检索中国知网、万方数据服务平台、中国生物医学数据库以及维普期刊资源整合服务平台、Cochrane Library、EMBASE、Pub Med、Web of Science等国内外数据库中有关基于跨理论模型的健康教育应用于2型糖尿病患者的随机对照试验。经筛选文献,提取资料与评价文献质量后,采用RevMan5.3软件进行Meta分析。结果最终纳入7篇文献,共1082例患者。Meta分析结果显示,基于跨理论模型的健康教育能够降低2型糖尿病患者的HbA1c,差异有统计学意义[WMD=-0.53,95%CI(-0.73,-0.34),P<0.01];在对降低空腹血糖效果方面,亚组分析的结果显示,干预3个月和6个月能显著降低空腹血糖,与对照组比较差异有统计学意义[WMD=-0.74,95%CI(-1.01,-0.47),P<0.01;WMD=-1.14,95%CI(-1.33,-0.95),P<0.01],而干预12个月,与对照组比较差异无统计学意义[WMD=-0.17,95%CI(-1.03,0.70),P=0.71];与对照组在改善体质指数上比较差异无统计学意义[WMD=-0.41,95%CI(-1.18,0.37),P=0.30]。结论基于跨理论模型的健康教育一定程度上能够更好的促进患者不健康行为的转变,能有效的改善糖化血红蛋白。同时短期的干预(3/6个月)对空腹血糖的降低效应显著高于常规健康教育方法,但长期的干预(12个月)对糖化血红蛋白的降低效果不明显。此外,在对改善体质指数方面亦无明显作用。

Objective To evaluate the effectiveness of transtheoretical model-based health education for glycaemic control in patients with type 2 diabetes. Methods We searched databases including CNKI, Wanfang, CBM, Weipu, Cochrane Library, Pub Med, Web of Science, and EMBASE. We included all randomized controlled trials (RCTs) that reported the efficacy of transtheoretical model-based health education for type 2 diabetes patients. We selected studies according to inclusion and exclusion criteria, extracted data, and assessed the quality. We used Rev Man 5.3 software to conduct meta-analysis. Results A total of 7 RCTs including 1 082 patients were included in this meta-analysis. The meta-analysis showed that transtheoretical model-based health education could improve HbA1c in patients with type 2 diabetes [WMD=-0.53,95% CI (-0.73,-0.34), P < 0.01]. The results supported that the short-term intervention (3 or 6 months) could decrease fasting blood glucose (FBG)[WMD=-0.74, 95% CI (-1.01,- 0.47), P < 0.01;WMD=-1.14, 95% CI (-1.33,-0.95), P < 0.01], but failed to support the effectiveness of the long-term intervention (12 months)[WMD=-0.17, 95% CI (-1.03, 0.70), P=0.71]. In addition, it failed to support the effectiveness on reducing body mass index (BMI)[WMD=-0.41,95% CI (-1.18, 0.37), P=0.30]. Conclusion Transtheoretical model-based health education can better promote the transformation of patients' unhealthy behaviors and facilitate the control of blood glucose, but can not effectively reduce BMI.