Intervention Review

Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus

  1. Etienne IJJ Vermeire1,*,
  2. Johan Wens2,
  3. Paul Van Royen2,
  4. Yves Biot3,
  5. Hilary Hearnshaw4,
  6. Antje Lindenmeyer5

Editorial Group: Cochrane Metabolic and Endocrine Disorders Group

Published Online: 20 APR 2005

Assessed as up-to-date: 30 JAN 2002

DOI: 10.1002/14651858.CD003638.pub2

How to Cite

Vermeire EIJJ, Wens J, Van Royen P, Biot Y, Hearnshaw H, Lindenmeyer A. Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD003638. DOI: 10.1002/14651858.CD003638.pub2.

Author Information

  1. 1

    University of Antwerp , Centre for General Practice, Antwerpen, Belgium

  2. 2

    University of Antwerp, Centre for General Practice, Antwerpen, Belgium

  3. 3

    GP, General Practitioner, Antwerp, Belgium

  4. 4

    University of Warwick, Centre for Primary Health Care Studies, Coventry, UK

  5. 5

    Warwick Medical School, University of Warwick, Health Sciences Research Institute, Coventry, UK

*Etienne IJJ Vermeire, Centre for General Practice, University of Antwerp , Universiteitsplein 1, Antwerpen, 2610, Belgium. etienne.vermeire@ua.ac.be.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 APR 2005

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Research suggests adherence to treatment recommendations is low. In type 2 diabetes, which is a chronic condition slowly leading to serious vascular, nephrologic, neurologic and ophthalmological complications, it can be assumed that enhancing adherence to treatment recommendations may lead to a reduction of complications. Treatment regimens in type 2 diabetes are complicated, encompassing life-style adaptations and medication intake.

Objectives

To assess the effects of interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus.

Search methods

Studies were obtained from searches of multiple electronic bibliographic databases supplemented with hand searches of references.

Selection criteria

Randomised controlled and controlled clinical trials, before-after studies and epidemiological studies, assessing changes in adherence to treatment recommendations, as defined in the objectives section, were included.

Data collection and analysis

Two teams of reviewers independently assessed the trials identified for inclusion. Three teams of two reviewers assessed trial quality and extracted data. The analysis for the narrative part was performed by one reviewer (EV), the meta-analysis by two reviewers (EV, JW).

Main results

Twenty-one studies assessing interventions aiming at improving adherence to treatment recommendations, not to diet or exercise recommendations, in people living with type 2 diabetes in primary care, outpatient settings, community and hospital settings, were included. Outcomes evaluated in these studies were heterogeneous, there was a variety of adherence measurement instruments. Nurse led interventions, home aids, diabetes education, pharmacy led interventions, adaptation of dosing and frequency of medication taking showed a small effect on a variety of outcomes including HbA1c. No data on mortality and morbidity, nor on quality of life could be found.

Authors' conclusions

Current efforts to improve or to facilitate adherence of people with type 2 diabetes to treatment recommendations do not show significant effects nor harms. The question whether any intervention enhances adherence to treatment recommendations in type 2 diabetes effectively, thus still remains unanswered.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus

Twenty-one studies assessing interventions to improve adherence to treatment recommendations, not to diet or exercise, in people with type 2 diabetes in different settings (outpatients, community, hospitals, primary care) were included. There were many outcomes evaluated in these studies and a variety of adherence measurement instruments was used. Nurse led interventions, home aids, diabetes education and pharmacy led interventions showed a very small effect on some outcomes including metabolic control. No data on mortality or morbidity, nor on quality of life could be found.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

改善2型糖尿病患治療建議的遵囑性之介入

研究顯示治療建議落實的比例低。第2型糖尿病患是一種慢性疾病,緩慢導致包括血管、腎臟、神經和眼睛等嚴重併發症,因此加強落實治療建議是可以假設能減少併發症的發生。第2型糖尿病的治療方案是複雜的,包括生活方式的調整和攝取藥物。

目標

評估改善第二型糖尿病患落實治療建議的措施之效果。

搜尋策略

研究的取得是搜查多個電子書目數據庫輔以手工檢索的文獻參考。最後一次搜查日期為2002年11月。

選擇標準

評估治療建議遵囑性的改變有關的對照與隨機對照的臨床試驗、前後研究和流行病學研究都包括在內,至於治療建議遵囑性在目的章節已定義。

資料收集與分析

兩個小組的審評專家獨立評估被選入的試驗。兩位為一組,共三組審評專家評估試驗的品質並擷取資料。敘述部分的分析是由一個審評專家負責,在統合分析則是由兩個審評審評專家負責。

主要結論

21個評估第二型糖尿病的改善治療建議遵囑性的研究,地點包括初級照顧、門診、社區和醫院,而遵囑性不是針對節食或運動。這些研究所評估的結果(outcomes)是異質性,存在著各種各樣測量遵囑性的工具。護士主導介入、居家輔助用具、糖尿病教育、藥房主導的介入、適應服藥劑量和頻率,顯示對不同的結果包括糖化血色素有些許影響。至於死亡率、發病率和生活品質則沒有相關的研究數據。

作者結論

目前改善或促進第二型糖尿病治療建議的遵囑性的努力並沒有顯示有效或損害,因此採取何種介入方式去有效率的加強第二型糖尿病治療建議的遵囑性仍然沒有答案。

翻譯人

本摘要由慈濟醫院傅振宗翻譯。

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

總結

有效的介入方式去加強第二型糖尿病治療建議的遵囑性仍然有其必要性,21個評估介入方式對改善第二型糖尿病治療建議的遵囑性的研究,地點包括門診、社區、醫院和初級照顧,而遵囑性不是針對節食或運動。這些研究評估許多種結果,同時使用各種測量遵囑性的工具。護士主導介入、居家輔助用具、糖尿病教育、藥房主導的介入顯示對一些結果包括血糖控制有些許影響。至於死亡率、發病率和生活品質則沒有相關的研究數據。