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

Abstract

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. To assess the effects of group-based, patient-centred training on clinical, lifestyle and psychosocial outcomes in people with type 2 diabetes. 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. 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. 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. 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. 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. 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。 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 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。 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。 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。 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 2型糖尿病症例の自己管理戦略に向けたグループベースのトレーニング 糖尿病を管理するためには、糖尿病症例の自己管理技能を導入することが不可欠であると認識されている。しかし、教育を行い、自己管理技能を教える最も有効な方法がはっきりしていない。 2型糖尿病症例を対象に、臨床的アウトカム、ライフスタイルに関するアウトカムおよび心理社会的アウトカムに対する患者を中心に置いたグループベースのトレーニングの効果を評価する。...