Group based training for self-management strategies in people with type 2 diabetes mellitus

 

Abstract

Background

It has been recognised that adoption of self-management skills by the person with diabetes is necessary in order to manage their diabetes. However, the most effective method for delivering education and teaching self-management skills is unclear.

Objectives

To assess the effects of group-based, patient-centred training on clinical, lifestyle and psychosocial outcomes in people with type 2 diabetes.

Search methods

Studies were obtained from computerised searches of multiple electronic bibliographic databases, supplemented by hand searches of reference lists of articles, conference proceedings and consultation with experts in the field.

Selection criteria

Randomised controlled and controlled clinical trials which evaluated group-based education programmes for adults with type 2 diabetes compared with routine treatment, waiting list control or no intervention. Studies were only included if the length of follow-up was six months or more and the intervention was at least one session with the minimum of six participants.

Data collection and analysis

Two reviewers independently extracted data and assessed study quality. A meta-analysis was performed if there were enough homogeneous studies reporting an outcome at either four to six months, 12-14 months, or two years, otherwise the studies were summarised in a descriptive manner.

Main results

Fourteen publications describing 11 studies were included involving 1532 participants. The results of the meta-analyses in favour of group-based diabetes education programmes were reduced glycated haemoglobin at four to six months (1.4%; 95% confidence interval (CI) 0.8 to 1.9; P < 0.00001), at 12-14 months (0.8%; 95% CI 0.7 to 1.0; P < 0.00001) and two years (1.0%; 95% CI 0.5 to 1.4; P < 0.00001); reduced fasting blood glucose levels at 12 months (1.2 mmol/L; 95% CI 0.7 to 1.6; P < 0.00001); reduced body weight at 12-14 months (1.6 Kg; 95% CI 0.3 to 3.0; P = 0.02); improved diabetes knowledge at 12-14 months (SMD 1.0; 95% CI 0.7 to 1.2; P < 0.00001) and reduced systolic blood pressure at four to six months (5 mmHg: 95% CI 1 to 10; P = 0.01). There was also a reduced need for diabetes medication (odds ratio 11.8, 95% CI 5.2 to 26.9; P < 0.00001; RD = 0.2; NNT = 5). Therefore, for every five patients attending a group-based education programme we could expect one patient to reduce diabetes medication.

Authors' conclusions

Group-based training for self-management strategies in people with type 2 diabetes is effective by improving fasting blood glucose levels, glycated haemoglobin and diabetes knowledge and reducing systolic blood pressure levels, body weight and the requirement for diabetes medication.

 

Plain language summary

Group-based training for self-management strategies in people with type 2 diabetes results

Adults with type 2 diabetes who have participated in group-based training programmes show improved diabetes control (fasting blood glucose and glycated haemoglobin) and knowledge of diabetes in the short (four to six months) and longer-term (12 to 14 months) whilst also having a reduced need for diabetes medication. There is also some evidence that group-based education programmes may reduce blood pressure and body weight, and increase self-empowerment, quality of life, self-management skills and treatment satisfaction. However, as only a small number of studies evaluated those outcomes, more research is required to confirm those findings.

 

摘要

背景

第2型糖尿病患以團體基礎訓練之自我管理策略

糖尿病患為了治療他們的糖尿病必須有自我管理糖尿病之技巧。不過怎麼施行衛教、教導自我管理技巧之最有效方法，仍未明。

目標

以第2型糖尿病患為對象，評估以團體為基礎、病人為中心的訓練對其臨床、生活形態以及心理社會狀態結果之影響

搜尋策略

電腦搜尋許多研究之眾多資料，輔以手動搜尋相關文獻表章、大會摘要、專家諮詢。最近搜尋日期2003二月。

選擇標準

第2型糖尿病成人之隨機控制與控制性之臨床試驗，評估團體為基礎之衛教計畫，比較常規治療、候表控制或沒有處理的方式。納入的研究需追蹤時間超過六個月，一次課程至少六人以上。

資料收集與分析

兩位專家獨立選取數據並且評估研究的品質。針對有報告結果、如果是4 – 6個月、12 – 14個月、或2年的結果報告，且有足夠多的同質性研究，則使用統合分析；其他則以描述方式做成摘要。

主要結論

有14篇文章描述1532個人參與的11個研究，統合分析結果顯示以團體為基礎的糖尿病衛教課程有幫助的包括4 – 6個月(1.4%; 95% confidence interval (CI)0.8 to 1.9; P < 0.00001)、12 – 14個月(0.8%; 95% CI 0.7 to 1.0; P <0.00001)以及兩年(1.0%; 95% CI 0.5 to 1.4; P <0.00001) 均降低糖化血色素；在第12個月降低空腹血糖(1.2 mmol/L; 95% CI 0.7 to1.6; P < 0.00001)；在第12 – 14個月降低體重(1.6 Kg; 95% CI 0.3 to 3.0; P = 0.02)；在第12 – 14個月改善糖尿病之知識(SMD 1.0; 95% CI 0.7 to1.2; P < 0.00001)；在第4 – 6個月降低收縮血壓(5 mmHg: 95% CI 1 to 10; P = 0.01)。同時也減少了糖尿病用藥(odds ratio 11.8, 95% CI 5.2 to26.9; P < 0.00001; RD = 0.2; NNT = 5)。因此可預期5位病人參加以團體為基礎的衛教課程有一位可以減少糖尿病用藥。

作者結論

第2型糖尿病患以團體基礎訓練之自我管理策略有效改善空腹血糖、糖化血色素以及糖尿病知識，降低收縮壓、體重以及糖尿病用藥。

翻譯人

本摘要由慈濟醫院吳篤安翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

第2型糖尿病患以團體基礎訓練之自我管理策略可以改善糖尿病。第2型糖尿病成人參加團體基礎之訓練課程可以改善糖尿病的控制(空腹血糖與糖化血色素)、短期內增進糖尿病知識(4 – 6個月)以及長期降低糖尿病用藥量的需求(12 – 14個月)。還有證據顯示這種衛教課程可以降低血壓與體重，增進自我賦能、生活品質、自我照護技巧以及治療的滿意度。然而，只有少量的研究評估這樣的結果，還需要更多的研究來證實。