不同非药物干预方案对儿童和青少年1型糖尿病血糖管理影响的网状Meta分析

Network Meta-analysis of the impact of different non-pharmacological interventions on blood glucose management in children and adolescents with type 1 diabetes

目的将不同非药物干预方案对儿童和青少年1型糖尿病血糖管理的影响通过贝叶斯网状Meta分析的方法进行评价、排序。方法通过计算机检索PubMed、Web of Science、Cochrane Library、Embase、CINAHL、中国生物医学文献数据库、中国知网、万方数据库及维普数据库、中国/美国临床注册中心,检索时限为各数据库建立开始至2020年12月。使用WinBUGS、GeMTC、Stata软件进行血糖管理数据分析。结果最终纳入37篇文献,共4188例,涉及14种非药物干预方案。网状Meta分析结果显示,当使用不同非药物干预方案时,儿童和青少年1型糖尿病血糖管理有效性排序为:同伴支持教育第1位、认知行为疗法第2位、高级糖尿病教育第3位、家庭支持干预第4位、引导式自主决定干预第5位、个案训练第6位、积极心理干预第7位、基于手机的远程干预第8位、糖尿病教育第9位、支持性咨询第10位、基于网络的远程干预第11位、多系统疗法第12位、常规护理第13位、动机性访谈第14位。结论同伴支持教育和认知行为疗法在儿童和青少年1型糖尿病血糖管理方面显示出一定优势,而动机性访谈表现最差。在未来的研究中将进一步考虑非药物干预方案的其他潜在好处,例如情绪健康和糖尿病自我管理行为。

Objective To evaluate and rank the effects of different non-pharmaceutical interventions on the management of blood glucose in children and adolescents with type 1 diabetes by Bayesian network Meta-analysis.Methods Computer search for PubMed,Web of Science,Cochrane Library,Embase,CINAHL,China Biomedical Literature Database,China Knowledge Network,Wangfang Data and VIP Database,China and the United States Clinical Registration Center,the search time limit is from the establishment of each database to December 2020.Use WinBUGS,GeMTC,Stata software for blood glucose management data analysis.Results Finally,37 articles were included,with a total of 4188 cases,involving 14 non-pharmaceutical intervention programs.The results of the network Meta-analysis showed that when different non-pharmacological interventions were used,the effectiveness of blood glucose management in children and adolescents with type 1 diabetes was ranked as follows:peer support education first,cognitive behavioral therapy second,advanced diabetes education third,family support intervention fourth,self guided intervention(GSD-Y)fifth,case training sixth,positive psychological intervention seventh,mobile phone based remote intervention eighth,diabetes education ninth,supportive consultation tenth,network based remote intervention eleventh position,multi-system therapy multi system therapy twelfth,conventional nursing thirteenth,motivational interview fourteenth.Conclusions The available evidence shows that peer support education and cognitive behavioral therapy show certain advantages in blood glucose management in children and adolescents with type 1 diabetes,while motivational interviews perform the worst.Future research will further consider other potential benefits of non-pharmacological interventions,such as emotional health and diabetes self-management behavior.