Pendidikan pesakit secara individu untuk penghidap diabetes mellitus jenis 2
Abstract
Background
Type 2 diabetes is a common and costly chronic disease which is associated with significant premature mortality and morbidity. Although patient education is an integral component of diabetes care, there remain uncertainties regarding the effectiveness of different methods and modes of education.
Objectives
To evaluate the effectiveness of individual patient education on metabolic control, diabetes knowledge and psychosocial outcomes.
Search methods
Multiple electronic bibliographic databases were searched, including The Cochrane Library, MEDLINE, Premedline, ERIC, Biosis, AMED, Psychinfo, EMBASE, CINAHL, APAIS‐health, Australian Medical Index, Web of Science, dissertation abstracts and Biomed Central.
Selection criteria
Randomized controlled and controlled clinical trials which evaluated individual education for adults with type 2 diabetes. The intervention was individual face‐to‐face patient education while control individuals received usual care, routine treatment or group education. Only studies that assessed outcome measures at least six months from baseline were included.
Data collection and analysis
Information was extracted by two reviewers who summarized both study characteristics and outcome statistics. A meta‐analysis using a fixed‐effect model was performed if there were adequate studies with a specified outcome of sufficient homogeneity. For outcomes where there were too few studies or the assessment measurements were not standardized or variable, the results were summarised qualitatively.
Main results
Nine studies involving 1359 participants met the inclusion criteria. Six studies compared individual education to usual care and three compared individual education to group education (361 participants). There were no long‐term studies and overall the quality of the studies was not high. In the six studies comparing individual face‐to‐face education to usual care, individual education did not significantly improve glycaemic control (weighted mean difference (WMD) in HbA1c ‐0.1% (95% confidence interval (CI) ‐0.3 to 0.1, P = 0.33) over a 12 to 18 month period. However, there did appear to be a significant benefit of individual education on glycaemic control in a subgroup analysis of three studies involving participants with a higher mean baseline HbA1c greater than 8% (WMD ‐0.3% (95% CI ‐0.5 to ‐0.1, P = 0.007). In the two studies comparing individual to group education, there was no significant difference in glycaemic control between individual or group education at 12 to 18 months with a WMD in HbA1c of 0.03% (95% CI ‐0.02 to 0.1, P = 0.22). There was no significant difference in the impact of individual versus usual care or group education on body mass index systolic or diastolic blood pressure. There were too few studies to perform a meta‐analysis on the effect of individual education on dietary self management, diabetes knowledge, psychosocial outcomes and smoking habits. No data were available on the other main outcome measures of diabetes complications or health service utilization and cost analysis in these studies.
Authors' conclusions
This systematic review suggests a benefit of individual education on glycaemic control when compared with usual care in a subgroup of those with a baseline HbA1c greater than 8%. However, overall there did not appear to be a significant difference between individual education and usual care. In the small number of studies comparing group and individual education, there was an equal impact on HbA1c at 12 to 18 months. Additional studies are needed to delineate these findings further.
PICO
Plain language summary
Pendidikan pesakit secara individu untuk penghidap diabetes mellitus jenis 2
Sembilan kajian yang melibatkan 1359 peserta memenuhi kriteria kemasukan. Enam kajian membandingkan pendidikan secara individu dengan penjagaan biasa dan tiga kajian membandingkan pendidikan secara individu dengan pendidikan secara berkumpulan (361 peserta). Tiada kajian jangka panjang dan keseluruhannya, kualiti kajian‐kajian ini tidak tinggi. Pendidikan kesihatan secara individu bersemuka untuk penghidap diabetes jenis 2 selama enam hingga dua belas bulan tidak meningkatkan kawalan glisemik, indeks jisim badan (ukuran untuk berat badan berlebihan; berat badan (kilogram) dibahagikan dengan kuasa dua ketinggian badan (meter), kg/m2),tekanan darah atau kadar kolesterol dengan ketara dalam jangka masa pendek atau sederhana berbanding penjagaan biasa. Walaubagaimanapun, manfaat yang ketara pendidikan secara individu terhadap kawalan glisemik dapat diperhatikan dalam analisa subkumpulan kajian‐kajian yang melibatkan peserta yang mempunyai paras dasar HbA1c lebih daripada 8% (iaitu, kadar glukosa darah yang sangat tinggi sepanjang beberapa bulan atau ‘kawalan metabolik’ tidak mencukupi). Dalam kajian‐kajian yang membandingkan pendidikan individu dengan pendidikan berkumpulan, tiada perbezaan yang ketara antara pendidikan individu atau berkumpulan dari 12 hingga 18 bulan atau perbezaan yang ketara tentang impak pendidikan individu berbanding dengan berkumpulan terhadap indeks jisim badan, tekanan darah sistolik atau diastolik.
Analisis terhadap penjagaan kendiri tentang pemakanan, pengetahuan diabetes, keputusan psikososial dan tabiat merokok tidak dapat dilaksanakan kerana limitasi kajian‐kajian yang ada dan penggunaan alat pengukuran yang berbeza. Walaubagaimanapun, penilaian deskriptif mencadangkan bahawa tiada perbezaan ketara terhadap kualiti hidup, kemahiran penjagaan kendiri atau pengetahuan antara pendidikan berkumpulan dan individu. Apabila pendidikan individu dibandingkan dengan penjagaan biasa, limitasi jumlah kajian‐kajian yang ada mencadangkan bahawa keputusan terhadap penjagaan kendiri, tabiat merokok dan pengetahuan adalah positif. Walaubagaimanapun, terdapat percanggahan bukti terhadap keputusan psikososial. Tiada data tentang hasil pengukuran utama yang lain untuk komplikasi diabetes atau penggunaan perkhidmatan kesihatan dan analisis kos dalam kajian‐kajian ini.
