利拉鲁肽对2型糖尿病患者血糖波动的影响——基于临床随机对照研究的Meta分析

目的 系统评价利拉鲁肽对2型糖尿病（T2DM）患者血糖波动的影响。方法 以“利拉鲁肽、2型糖尿病、血糖波动”为中文检索词,以“type 2 diabetes mellitus、liraglutide、glucose variability”为英文检索词,检索中国知网、万方、维普、中国生物医学文献、PubMed、Embase、Web of Science、Cochrane Library数据库,检索时间从建库至2021年5月31日。收集应用利拉鲁肽治疗T2DM的国内外随机对照研究,提取相关数据,应用Revman 5.3软件进行Meta分析。结果 共纳入10篇文献,669例患者。Meta分析显示,T2DM患者应用利拉鲁肽治疗后平均血糖波动幅度可明显降低（MD=-1.42,95%CI:-1.75～-1.09,P<0.001）。结论 本研究表明,在临床治疗中,利拉鲁肽可有效减少T2DM患者血糖波动。     

Culturally competent interventions in Type 2 diabetes mellitus management: an equity-oriented literature review

Objectives. Although, culturally competent (CC) interventions aim to reduce health inequalities for ethnic minorities, they have been criticized on the grounds that they increase prejudice and stereotyping. It remains unclear whether CC interventions really can reduce health inequalities among ethnic minorities. The purpose of this review is to assess whether CC interventions in the management of Type 2 diabetes mellitus (T2DM) match the recommendations to reduce health inequalities.

Design. We identified CC interventions relating to T2DM among ethnic minority patients in the literature published between 2005 and 2011. Data were analyzed according to an equity-oriented framework. Each study was given a score based on its congruence with the reduction of health inequalities amongst ethnic minorities.

Results. We reviewed 137 papers and found 61 studies that met the inclusion criteria. Most interventions focused on the individual level and the modification of patients' health behavior. Very few addressed the sociopolitical level. A minority of the studies acknowledged the role of socioeconomic deprivation in ethnic health inequalities. Half of the studies contained no information about the socioeconomic status of the patients. The patients receiving the interventions were socioeconomically deprived. Only 10 studies compared ethnic minority groups to majority groups. Thirty-three studies had a very low average congruence score. The highest score of congruence was achieved by one study.

Conclusion. Overall, CC interventions addressing T2DM are not congruent with the reduction of ethnic health inequalities. The future of CC interventions may involve going one step further and going back to basic tenets of cultural competence: the integration of difference, whatever its source, into the delivery of fair health care for patients.     

妊娠期糖尿病与产后抑郁关系的Meta分析

目的 系统评价妊娠期糖尿病与产后抑郁的关系。方法 检索Embase、Cochrane Library、PubMed、Web of Science、PsycINFO、中国知网、万方及维普数据库中探讨糖尿病与产后抑郁关系的研究,时限均从建库至2020年7月1日。同时对最终纳入的文献进行数据提取与质量评价,并采用Stata 14.0软件进行Meta分析。结果 最终纳入13项队列研究,共计736598名患者。文献质量评价均处于中高水平。Meta分析结果显示:妊娠期糖尿病与产后抑郁呈显著相关性（OR=2.02,95%CI: 1.44～2.81,P<0.001）。亚组分析显示:不同研究地区或国家［伊朗(OR=2.04)、美国(OR=1.47)、欧洲(OR=2.60)］、糖尿病诊断依据［临床诊断(OR=2.02)、自我报告(OR=1.87)］、产后抑郁评估期［产后6周及以下(OR=2.00)、产后6周以上(OR=2.14)］、抑郁测量工具［EPDS (OR=2.05)、ICD (OR=1.57)］中妊娠期糖尿病均与产后抑郁呈显著相关性。结论 产妇妊娠期糖尿病与产后抑郁具有显著相关性,糖尿病是产后抑郁的危险因素。     

Meta-analysis of health behavior change interventions in type 1 diabetes

OBJECTIVES: To meta-analyze research testing interventions to improve health behaviors including exercise among adults with type 1 diabetes. METHODS: Multiple literature-searching strategies identified published and unpublished studies reporting glycated hemoglobin outcomes. Fixed- and random-effects meta-analyses included moderator effects. RESULTS: Data were synthesized across 1435 subjects. The overall effect size was 0.26. This translates into a reduction of 0.33 in mean HbA1c levels between treatment (8.47%) and control (8.80%) groups. Effect sizes were larger with more females, lower body mass index, higher baseline HbA1c, and interventions targeting multiple behaviors. CONCLUSIONS: Behavior change interventions improve metabolic control in type 1 diabetes.     

宜宾城区糖尿病患者社区管理的效果评价

目的了解宜宾城区糖尿病患者社区管理的应用效果,探讨糖尿病社区管理的新模式。方法于2017年1月至2017年6月抽取宜宾城区建立糖尿病健康档案的患者219例为社区管理组,选择同期于宜宾市第一人民医院住院治疗的糖尿病患者150例为对照组,分别采用全面综合社区管理模式和普通院外管理模式进行糖尿病家庭管理,观察其血糖和糖化血红蛋白、血糖控制情况和膳食依从性情况等。结果早中晚三餐餐后血糖和午、晚餐餐前血糖差异均有统计学意义(P<0.05),管理3月后和6月后两组患者HbAlc差异有统计学意义(P<0.05)。除生存技能两组差异无统计学意义外,自觉症状、生活习惯、治疗情况、治疗目标、疾病知识和CSSD总分社区管理组高于医院管理组(P<0.05)。两组患者膳食总能量和碳水化合物摄入量高于推荐量,医院管理组高于社区干预组,膳食纤维却远低于推荐量,医院管理组低于社区干预组(P<0.05)。结论综合性社区管理模式对糖尿病患者血糖控制和膳食依从性有着积极作用,值得在社区和基层推广。     

个体化营养干预对2型糖尿病糖脂代谢影响的Meta分析

目的系统评价个体化营养干预如何影响2型糖尿病糖脂代谢。方法检索文献库:知网(CNKI)、万方、维普网、PUBMED、EBSCO等。纳入关于2型糖尿病糖脂代谢的个体化营养干预RCT试验。干预组为个体化营养干预,对照组为常规护理。结果我们最终纳入8项研究,样本量共928例。干预组与对照组相比,空腹血糖及2 h餐后血糖:[MD=-1.05,95%CI(-1.26,-0.84),P<0.05]、[MD=-1.18,95%CI(-1.42,-0.94),P<0.05];糖化血红蛋白及甘油三酯:[MD=-0.96,95%CI(-1.17,-0.74),P<0.05]、[MD=-0.38,95%CI(-0.48,-0.27),P <0.05];胰岛素抵抗指数及总胆固醇:[MD=-0.93,95%CI(-1.23,-0.63),P<0.05]、[MD=-0.51,95%CI(-0.63,-0.39),P<0.05]。结论个体化营养干预将有效改善2型糖尿病患者的糖脂代谢,应鼓励社区和医院实施。     

The impact of psychosocial interventions on condom and contraceptive use in LMICs: Meta-analysis of randomised controlled trials

ABSTRACT

Inconsistent contraceptive use and risky sexual behaviour perpetuate the burden of sexually transmitted diseases, especially in low- and middle-income countries (LMIC). Psychosocial interventions (PSI) can contribute to change sexual behaviour, however, their overall effectiveness is unclear. We thus conducted a meta-analysis of the effectiveness of PSIs to increase condom and contraceptive use in LMICs. Seven databases were searched systematically for randomised trials comparing a PSI with a control condition. Risk ratios of 31 eligible studies were pooled in random-effects analyses for condom and contraceptive use and unprotected sex, using sensitivity analyses to further investigate the results. Risk of bias was assessed using the Cochrane tool, and heterogeneity and publication bias were assessed. PSIs increased condom use by about 6% at post-test and 8% at follow-up as compared to control conditions. Contraceptive use was increased by about 14% at post-test. There were no effects on unprotected sex. Results suggest that PSIs have the potential to increase contraceptive and, to a smaller degree, condom use in LMICs. The reliability of these results is partly limited by heterogeneity and the risk of publication bias. PSIs were further found to provide substantial benefits to the exposed populations beyond the targeted outcomes.     

中国儿童青少年糖尿病患病率Meta分析

采用Meta分析了解中国儿童青少年糖尿病流行情况,为糖尿病的早期防治提供科学依据.方法 系统检索中国期刊全文数据库(CNKI)、万方数据资源系统(Wan-fang)、维普数据库(VIP)和PubMed中2000年1月1日至2015年12月31日期间所有关于儿童青少年DM患病率研究的文献.中文检索策略以主题词、摘要、题名以及关键词分别进行“儿童”或“青少年”+“糖尿病”或“血糖升高”+“患病率”或“流行”或“趋势”检索.外文检索策略为(child * ORadolescent*OR prepubescent*OR postpubescent*OR pubescent*OR youth*OR teen*)AND (diabetes OR diabetes mel-litus OR DM) AND (prevalence OR incidence OR epidemiology OR trend) AND (China OR Chinese).采用Stata 12.0软件进行数据合并,采用随机效应模型和自然对数转换法计算合计患病率,按诊断标准、性别和年龄段进行亚组分析.结果 共纳入8篇文献(5篇中文、3篇英文).Meta分析显示,中国儿童青少年糖尿病患病率为0.80‰(95% CI=0.17‰~3.73‰).亚组分析中,按照诊断标准进行分组,WHO标准诊断糖尿病,中国儿童青少年糖尿病患病率为1.73‰(95%CI=0.70%~4.26‰),高于美国糖尿病学会标准诊断糖尿病患病率的0.49‰(95%CI=0.12‰~1.89‰);按性别分层后,男、女生糖尿病合并患病率分别为0.93‰(95% CI=0.07‰~12.22‰)和0.62‰(95% CI=0.11‰~3.48‰),男生略高于女生;按年龄段分组,13~18岁的儿童青少年糖尿病合并患病率为1.13‰(95% CI=0.11‰~12.25‰),高于0~6岁的糖尿病合并患病率1.05‰(95%CI=0.09‰~ 12.92‰),7~12岁糖尿病合并患病率最低[0.87‰(95%CI=0.13‰~ 5.76‰)].结论 中国儿童青少年糖尿病的患病率较高,不同诊断标准对儿童青少年糖尿病的检出率影响较大.儿童青少年糖尿病的防治任务刻不容缓.     

维生素D补充对妊娠期糖尿病预防和治疗作用的Meta分析

目的系统评价维生素D补充对妊娠期糖尿病(GDM)的预防和治疗效果。方法通过系统检索中国知网(CNKI)、中国生物医学文献数据库(CBM)和维普期刊库、PubMed、Cochrane图书馆、Web of Science核心合集等数据库,以维生素D和妊娠期糖尿病及其相关词语为检索词,收集以维生素D补充作为干预措施来预防或治疗GDM的随机对照实验(RCT),检索时间是从建库到2018年2月28日。结果共检索到16项相关研究,其中6项是关于GDM预防作用的研究,Meta分析表明,补充维生素D降低了孕妇的空腹血糖(FPG)水平(SMD=-1. 87,95%CI-3. 39～-0. 35)和GDM的发病率(OR=0. 42,95%CI 0. 30～0. 60); 10项关于GDM治疗作用研究的Meta分析表明,补充维生素D显著降低GDM患者FPG水平(SMD=-0. 29,95%CI-0. 56～-0. 02)和空腹胰岛素(FINS)水平(SMD=-0. 42,95%CI-0. 69～-0. 15),改善了GDM患者的胰岛素抵抗(HOMA-IR)(SMD=-0. 53,95%CI-0. 89～-0. 17)和胰岛β细胞功能(HOMA-β)(SMD=-0. 39,95%CI-0. 61～-0. 18),增加了胰岛素敏感性(QUICKI)(SMD=0. 87,95%CI 0. 41～1. 32)。结论维生素D补充可改善胰岛素抵抗和胰岛β细胞功能以及增加胰岛素敏感性。     

微营养素对糖尿病的防治作用

微营养素与糖尿病及其并发症的发生、发展密切相关.本文就目前较为关注的微营养素锌、硒、镁、铬对糖尿病的防治作用做一综述.     

微营养素对糖尿病的防治作用

微营养素与糖尿病及其并发症的发生、发展密切相关。本文就目前较为关注的微营养素锌、硒、镁、铬对糖尿病的防治作用做一综述。     

The cost-utility of diet and exercise interventions in non-insulin-dependent diabetes mellitus

Substantial evidence suggests that obesity is associated withnon-insulin-dependent diabetes mellitus (NIDDM) and that weightreduction precedes improvements in glucose intolerance. However,achieving weight loss requires labour-intensive behaviouralinterventions. We evaluated the cost-utility of behaviouralinterventions in an experimental study of 76 NIDDM adults. Incomparison with an education control group, adults randomlyassigned to a diet-plus-exercise programme showed significantimprovement in health status over an eighteen-month period.Using a general health policy model, we estimated that the programmeproduced 0.092 well-years for each participant. Programme costswere estimated using usual charges for physical examinations,blood tests, ECG evaluations, behaviour modification, and medicalsupervision. These costs totalled approximately US $1000 perparticipant. The cost-utility ratio was US $1000/0.092 = $10870 per well-year. Using the general health policy model, thecost-utility of the behavioural intervention programmes wasshown to be competitive with other widely advocated medicalinterventions.     

糖尿病发病的社会心理风险因素流行病学研究进展

糖尿病的患病率和疾病负担不断增加,成为全球重大公共卫生问题。随着生物-心理-社会医学模式的提出,社会心理因素对糖尿病的影响逐渐引起重视。本文对影响糖尿病发病的社会心理因素流行病学研究进行综述,国外研究显示心理因素与糖尿病的发病密切相关,关于社会因素的研究较少且结论不一致。国内相关研究相对较少且多为小样本横断面研究,仍需更多纵向研究来证实社会心理因素对糖尿病发病的作用。     

知己健康管理对糖尿病患者血糖影响的Meta分析

目的:采用Meta分析研究知己健康管理对糖尿病患者血糖的影响.方法:全面收集有关糖尿病患者知己健康管理的随机对照试验文献,并运用Review Manager5.3统计软件从空腹血糖、餐后2h血糖、糖化血红蛋白3个方面进行Meta分析.结果:纳入本次Meta分析的文献共8篇.空腹血糖SMD=-0.44[95％ CI(-0.58,-0.30)],餐后2h血糖SMD=-0.64[95％CI(-0.79,-0.50)],糖化血红蛋白SMD=-0.64[95％CI(-1.02,-0.26)].结论:对糖尿病患者施行知己健康管理能够显著改善其血糖指标,具有一定的积极意义.     

血糖生成指数与糖尿病饮食管理

本文作者概述了食物血糖生成指数的概念、计算方法、对食物评价的意义以及在糖尿病饮食管理中的作用及应注意的问题.