Comparative Effects of Diabetes Self-Management Programs on Type 2 Diabetes Clinical Outcomes: A Systematic Review and Network Meta-Analysis

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes/Metabolism Research and Reviews Pub Date : 2024-09-12 DOI:10.1002/dmrr.3840

Debby Syahru Romadlon, Yu-Kang Tu, Yang-Ching Chen, Faizul Hasan, Rudy Kurniawan, Hsiao-Yean Chiu

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Abstract

Aims

This systematic review and network meta-analysis compared the effects of various diabetes self-management programs: Diabetes Self-Management Education (DSME), Diabetes Self-Management Support (DSMS), and Diabetes Self-Management Education and Support (DSMES).

Methods

We searched four electronic databases for eligible articles up to March 1, 2023. Only randomized controlled trials investigating the effects of DSME, DSMS, or DSMES on glycated haemoglobin (HbA1c) level, fasting blood glucose (FBG), total cholesterol (TC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) in adults with type 2 diabetes were included. Cochrane Risk of Bias 2.0 tool was used to assess each study quality, and Confidence in Network Meta-Analysis was applied to evaluate the certainty of the evidence. Data were pooled with a random-effects model under a frequentist framework.

Results

A total of 108 studies encompassing 17,735 participants (mean age 57.4 years) were analysed. DSMES, compared with usual care, significantly reduced HbA1c level (mean difference = −0.61%, 95% confidence interval [CI] = −0.74 to −0.49; certainty of evidence = moderate), FBG (−23.33 mg/dL; −31.33 to −15.34; high), TC (−5.62 mg/dL; −8.69 to −2.55; high), SBP (−3.05 mmHg; −5.20 to −0.91; high), and DBP (−2.15 mmHg; −3.36 to −0.95; high). Compared with DSME, DSMES showed significantly greater improvements in HbA1c levels (−0.23%; −0.40 to −0.07; high) and DBP (−1.82 mmHg; −3.47 to −0.17; high). DSMES was ranked as the top treatment for improving diabetes clinical outcomes (0.82–0.97) in people with type 2 diabetes.

Conclusions

DSMES, in people with type 2 diabetes, yields the greatest improvement in the key clinical outcomes of HbA1c, fasting blood glucose, and blood pressure levels. Healthcare providers should incorporate the DSMES approach into their daily care routines. Approximately 30% of the studies reviewed raised some concerns about their quality, underscoring the need for high-quality studies in this area.

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糖尿病自我管理计划对 2 型糖尿病临床结果的比较效应：系统回顾与网络元分析

目的本系统综述和网络荟萃分析比较了各种糖尿病自我管理计划的效果：糖尿病自我管理教育（DSME）、糖尿病自我管理支持（DSMS）和糖尿病自我管理教育与支持（DSMES）。方法我们在四个电子数据库中检索了截至 2023 年 3 月 1 日符合条件的文章。只纳入了调查糖尿病自我管理教育、糖尿病自我管理支持或糖尿病自我管理教育对成人 2 型糖尿病患者糖化血红蛋白 (HbA1c)、空腹血糖 (FBG)、总胆固醇 (TC)、收缩压 (SBP) 和舒张压 (DBP) 影响的随机对照试验。采用 Cochrane Risk of Bias 2.0 工具评估每项研究的质量，并采用网络置信度元分析评估证据的确定性。数据采用频数主义框架下的随机效应模型进行汇总。结果共分析了 108 项研究，涉及 17,735 名参与者（平均年龄为 57.4 岁）。与常规护理相比，DSMES 可显著降低 HbA1c 水平（平均差异 = -0.61%，95% 置信区间 [CI] = -0.74 至 -0.49；证据确定性 = 中等）、FBG（-23.33毫克/分升；-31.33至-15.34；高）、TC（-5.62毫克/分升；-8.69至-2.55；高）、SBP（-3.05毫米汞柱；-5.20至-0.91；高）和DBP（-2.15毫米汞柱；-3.36至-0.95；高）。与 DSME 相比，DSMES 对 HbA1c 水平（-0.23%；-0.40 至 -0.07；高）和 DBP（-1.82 mmHg；-3.47 至 -0.17；高）的改善幅度更大。DSMES 在改善 2 型糖尿病患者的糖尿病临床疗效（0.82-0.97）方面名列前茅。结论 DSMES 对 2 型糖尿病患者的主要临床疗效（HbA1c、空腹血糖和血压水平）改善最大。医疗服务提供者应将 DSMES 方法纳入日常护理常规。在所审查的研究中，约有 30% 的研究在质量方面存在一些问题，这突出表明该领域需要高质量的研究。

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来源期刊

Diabetes/Metabolism Research and Reviews 医学-内分泌学与代谢

CiteScore

17.20

自引率

2.50%

发文量

审稿时长

4-8 weeks

期刊介绍： Diabetes/Metabolism Research and Reviews is a premier endocrinology and metabolism journal esteemed by clinicians and researchers alike. Encompassing a wide spectrum of topics including diabetes, endocrinology, metabolism, and obesity, the journal eagerly accepts submissions ranging from clinical studies to basic and translational research, as well as reviews exploring historical progress, controversial issues, and prominent opinions in the field. Join us in advancing knowledge and understanding in the realm of diabetes and metabolism.