移动应用程序对糖尿病患者血糖控制效果的meta分析
|
摘要
目的评价移动应用程序在糖尿病患者血糖控制中的效果。方法计算机检索PubMed、EMbase、CENTRAL、中国生物医学文献数据库、中国知网、维普中文科技期刊数据库和万方数据库中相关的随机对照试验,检索时间为各数据库建库至2017年8月。对文献进行质量评价和数据提取,采用RevMan 5.3进行数据分析。结果共纳入26项随机对照试验,2 602例患者。Meta分析显示,与常规护理相比,使用移动应用程序的糖尿病患者糖化血红蛋白更低[加权均数差(WMD)=-0.43,95%CI (-0.57,-0.29),P<0.01];空腹血糖更低[WMD=-0.60,95%CI (-0.87,-0.33),P<0.01]。亚组分析显示,糖尿病患者使用移动应用程序的第3.0个月[WMD=-0.38,95%CI (-0.53,-0.23),P<0.01]、6.0个月[WMD=-0.39,95%CI(-0.57,-0.21),P<0.01]、9.0个月[WMD=-0.52,95%CI (-0.76,-0.28),P<0.01]的糖化血糖蛋白均比常规护理组低,而在第1.5个月[WMD=-0.08,95%CI (-0.26,0.10),P=0.38]和第12.0个月[WMD=-0.54,95%CI (-1.13,0.06),P=0.08],两组间差异无统计学意义。结论现有研究显示,移动应用程序在糖尿病患者血糖控制效果上优于常规护理。
Objective To evaluate the effect of mobile application program in glycemic control of diabetic patients.Methods The databases of PubMed,EMbase,CENTRAL,CBM,CNKI,VIP and Wanfang were retrieved by computer for collecting relevant randomized controlled trails(RCTs)and the retrieval time was from the date of their establishment to August 2017.The literature quality was evaluated and the data were extracted.Then the data were analyzed by using the RevMan 5.3 software.Results A total of 26 RCTs involving 2 602 patients were included.The meta analysis indicated that compared with the conventional nursing care,the glycosylated hemoglobin(A1 c)level in the patients with using the mobile application program was lower[weighted mean difference(WMD)=-0.43,95%CI(-0.57,-0.29),P<0.01]and fasting blood glucose was lower[WMD=-0.60,95%CI(-0.87,-0.33),P<0.01].The subgroup analysis showed that the A1 clevel in the patients using the mobile application program was lower than that in the patients with conventional nursing care in 3 months[WMD=-0.38,95%CI(-0.53,-0.23),P<0.01],6 months[WMD=-0.39,95%CI(-0.57,-0.21),P<0.01]and 9 months[WMD=-0.52,95%CI(-0.76,-0.28),P<0.01],but which in 1.5 months [WMD=-0.08,95%CI(-0.26,0.10),P=0.38]and 12.0 months[WMD=-0.08,95%CI(-0.26,0.10),P=0.38],the difference between the two groups had no statistical significance.Conclusion The current studies show that the mobile application program is superior to the conventional nursing care in the glycemic control effect of diabetic patients.
Objective To evaluate the effect of mobile application program in glycemic control of diabetic patients.Methods The databases of PubMed,EMbase,CENTRAL,CBM,CNKI,VIP and Wanfang were retrieved by computer for collecting relevant randomized controlled trails(RCTs)and the retrieval time was from the date of their establishment to August 2017.The literature quality was evaluated and the data were extracted.Then the data were analyzed by using the RevMan 5.3 software.Results A total of 26 RCTs involving 2 602 patients were included.The meta analysis indicated that compared with the conventional nursing care,the glycosylated hemoglobin(A1 c)level in the patients with using the mobile application program was lower[weighted mean difference(WMD)=-0.43,95%CI(-0.57,-0.29),P<0.01]and fasting blood glucose was lower[WMD=-0.60,95%CI(-0.87,-0.33),P<0.01].The subgroup analysis showed that the A1 clevel in the patients using the mobile application program was lower than that in the patients with conventional nursing care in 3 months[WMD=-0.38,95%CI(-0.53,-0.23),P<0.01],6 months[WMD=-0.39,95%CI(-0.57,-0.21),P<0.01]and 9 months[WMD=-0.52,95%CI(-0.76,-0.28),P<0.01],but which in 1.5 months [WMD=-0.08,95%CI(-0.26,0.10),P=0.38]and 12.0 months[WMD=-0.08,95%CI(-0.26,0.10),P=0.38],the difference between the two groups had no statistical significance.Conclusion The current studies show that the mobile application program is superior to the conventional nursing care in the glycemic control effect of diabetic patients.
引文
[1] WANG L,GAO P,ZHANG M,et al.Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J].JAMA,2017,317(24):2515-2523.
[2] HAYES A,ARIMA H,WOODWARD M,et al.Changes in quality of life associated with complications of diabetes:results from the ADVANCE study[J].Value Health,2016,19(1):36-41.
[3] PAGANO E,DE ROSA M,ROSSI E,et al.The relative burden of diabetes complications on healthcare costs:The population-based CINECA-SID ARNO Diabetes Observatory[J].Nutr Metab Cardiovasc Dis,2016,26(10):944-950.
[4] LIU W T,WANG C H,LIN H C,et al.Efficacy of a cell phone-based exercise programme for COPD[J].Eur Respir J,2008,32(3):651-659.
[5] LIU W T,HUANG C D,WANG C H,et al.A Mobile telephone-based interactive self-care system improves asthma control[J].Eur Respir J,2011,37(2):310-317.
[6] RYAN D,PRICE D,MUSGRAVE S D,et al.Clinical and cost effectiveness of Mobile phone supported self monitoring of asthma:multicentre randomized controlled trial[J].Br Med J,2012,344(12):e1756.
[7] VARNFIELD M,KARUNANITHI M,LEE C K,et al.Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients:results from a randomised controlled trial[J].Heart,2014,100(22):1770-1779.
[8] CUI M,WU X,MAO J,et al.T2DM Self-Management via smartphone applications:a systematic review and MetaAnalysis[J].PLoS One,2016,11(11):e166718.
[9] ALBERTI K G,ZIMMET P Z.Definition,diagnosis and classification of diabetes mellitus and its complications.Part 1:diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J].Diabet Med,1998,15(7):539-553.
[10]HIGGINS J,GREEN S.Cochrane handbook for systematic reviews of interventions version 5[M].New Jersey:Wiley-Blackwell,2011.
[11]KARDAS P,LEWANDOWSKI K,BROMURI S.Type 2diabetes patients benefit from the COMODITY12mHealth system:results of a randomised trial[J].J Med Syst,2016,40(12):259.
[12]ZHOU W,CHEN M,YUAN J,et al.Welltang-A smart phone-based diabetes management application-improves blood glucose control in Chinese People with diabetes[J].Diabetes Res Clin Pract,2016(116):105-110.
[13]BARON J S,HIRANI S,NEWMAN S P.A randomised,controlled trial of the effects of a mobile telehealth intervention on clinical and patient-reported outcomes in People with poorly controlled diabetes[J].J Telemed Telecare,2017,23(2):207-216.
[14]DRION I,PAMEIJER L R,VAN DIJK P R,et al.The effects of a mobile phone application on quality of life in patients with type 1diabetes mellitus:a randomized controlled trial[J].J Diabetes Sci Technol,2015,9(5):1086-1091.
[15]KIRWAN M,VANDELANOTTE C,FENNING A,et al.Diabetes self-management smartphone application for adults with type 1diabetes:randomized controlled trial[J].J Med Internet Res,2013,15(11):e235.
[16]NAGREBETSKY A,LARSEN M,CRAVEN A,et al.Stepwise self-titration of oral glucose-lowering medication using a mobile telephone-based telehealth platform in type 2diabetes:a feasibility trial in primary care[J].J Diabetes Sci Technol,2013,7(1):123-134.
[17]QUINN C C,SHARDELL M D,TERRIN M L,et al.Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control[J].Diabetes Care,2011,34(9):1934-1942.
[18]LIM S,KANG S M,SHIN H,et al.Improved glycemic control without hypoglycemia in elderly diabetic patients using the ubiquitous healthcare service,a new medical information system[J].Diabetes Care,2011,34(2):308-313.
[19]NOH J H,CHO Y J,NAM H W,et al.Web-based comprehensive information system for self-management of diabetes mellitus[J].Diabetes Technol Ther,2010,12(5):333-337.
[20]ISTEPANIAN R S,ZITOUNI K,HARRY D A,et al.Evaluation of a mobile phone telemonitoring system for glycaemic control in patients with diabetes[J].J Telemed Telecare,2009,15(3):125-128.
[21]LIM S,KANG S M,KIM K M,et al.Multifactorial intervention in diabetes care using real-time monitoring and tailored feedback in type 2diabetes[J].Acta Diabetol,2016,53(2):189-198.
[22]BEE Y M,BATCAGAN-ABUEG A P,CHEI C,et al.A smartphone application to deliver a Treat-to-Target insulin titration algorithm in Insulin-Naive patients with type2diabetes:apilot randomized controlled trial[J].Diabetes Care,2016,39(10):E174-176.
[23]KLEINMAN N J,SHAH A,SHAH S,et al.Impact of the gather mHealth system on a1C:primary results of a multisite randomized clinical trial among people with type2diabetes in India[J].Diabetes Care,2016,39(10):E169-170.
[24]WAKI K,FUJITA H,UCHIMURA Y,et al.DialBetics:A novel smartphone-based self-management support system for type 2diabetes patients[J].J Diabetes Sci Technol,2014,8(2):209-215.
[25]QUINN C C,CLOUGH S S,MINOR J M,et al.WellDoc Mobile diabetes management randomized controlled trial:Change in clinical and behavioral outcomes and patient and physician satisfaction[J].Diab Technol Therap,2008,10(3):160-168.
[26]KATALENICH B,SHI L,LIU S,et al.Evaluation of a remote monitoring system for diabetes control[J].Clin Ther,2015,37(6):1216.
[27]KARHULA T,VUORINEN A L,RAAPYSJARVI K,et al.Telemonitoring and mobile phone-based health coaching among finnish diabetic and heart disease patients:randomized controlled trial[J].J Med Internet Res,2015,17(6):e153.
[28]张斌.移动APP应用对2型糖尿病患者自我管理的辅助疗效研究[J].中国卫生产业,2016,13(23):78-80.
[29]乔娟,郝彦斐,燕增奎.基于智能手机的青中年2型糖尿病患者健康管理的效果观察[J].医疗卫生装备,2014,35(12):73-75.
[30]王朋朋,应燕萍,高忠兰,等.APP软件在2型糖尿病伴高血压出院患者延续护理中的应用[J].海南医学,2016,27(12):2057-2059,2060.
[31]HOLMEN H,TORBJORNSEN A,WAHL A K,et al.A Mobile health intervention for Self-Management and lifestyle change for persons with type 2diabetes,part 2:oneYear results from the Norwegian randomized controlled trial RENEWING HEALTH[J].JMIR Mhealth Uhealth,2014,2(4):e57.
[32]ORSAMA A L,LAHTEENMAKI J,HARNO K,et al.Active assistance technology reduces glycosylated hemoglobin and weight in individuals with type 2diabetes:results of a theory-based randomized trial[J].Diabetes Technol Ther,2013,15(8):662-669.
[33]RODRIGUEZ-IDIGORAS M I,SEPULVEDA-MUNOZ J A,MARTINEZ-GONZALEZ J L,et al.Telemedicine influence on the follow-up of type 2diabetes patients[J].Diabetes Technol Ther,2009,11(7):431-437.
[34]HSU W C,LAU K H,HUANG R,et al.Utilization of a Cloud-Based diabetes management program for insulin initiation and titration enables collaborative decision making between healthcare providers and patients[J].Diabetes Technol Ther,2016,18(2):59-67.
[35]YOO H J,PARK M S,KIM T N,et al.A ubiquitous chronic disease care system using cellular phones and the Internet[J].Diabetic Med,2009,26(6):628-635.
[36]CHARPENTIER G,BENHAMOU P Y,DARDARI D,et al.The diabeo software enabling individualized insulin dose adjustments combined with telemedicine support improves HbA1cin poorly controlled type 1diabetic patients:a 6-month,randomized,open-label,parallel-group,multicenter trial(TeleDiab 1study)[J].Diabetes Care,2011,34(3):533-539.
[37]ZHANG Y,HU G,YUAN Z,et al.Glycosylated hemoglobin in relationship to cardiovascular outcomes and death in patients with type 2diabetes:a systematic review and meta-analysis[J].PLoS One,2012,7(8):e42551.
[38]宋丹,徐土珍,刘玉慧,等.动机性访谈对2型糖尿病患者自我管理影响的meta分析[J].中华护理杂志,2014,49(9):1040-1045.
[39]PIBERNIK-OKANOVIC M,PRASEK M,POLJICANINFILIPOVIC T,et al.Effects of an empowerment-based psychosocial intervention on quality of Life and metabolic control in type 2 diabetic patients[J].Patient Educ Couns,2004,52(2):193-199.
[40]宋欢,高明霞,柳韦华.电话随访对糖尿病患者血糖控制效果的Meta分析[J].中国实用护理杂志,2017,33(8):627-633.
[2] HAYES A,ARIMA H,WOODWARD M,et al.Changes in quality of life associated with complications of diabetes:results from the ADVANCE study[J].Value Health,2016,19(1):36-41.
[3] PAGANO E,DE ROSA M,ROSSI E,et al.The relative burden of diabetes complications on healthcare costs:The population-based CINECA-SID ARNO Diabetes Observatory[J].Nutr Metab Cardiovasc Dis,2016,26(10):944-950.
[4] LIU W T,WANG C H,LIN H C,et al.Efficacy of a cell phone-based exercise programme for COPD[J].Eur Respir J,2008,32(3):651-659.
[5] LIU W T,HUANG C D,WANG C H,et al.A Mobile telephone-based interactive self-care system improves asthma control[J].Eur Respir J,2011,37(2):310-317.
[6] RYAN D,PRICE D,MUSGRAVE S D,et al.Clinical and cost effectiveness of Mobile phone supported self monitoring of asthma:multicentre randomized controlled trial[J].Br Med J,2012,344(12):e1756.
[7] VARNFIELD M,KARUNANITHI M,LEE C K,et al.Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients:results from a randomised controlled trial[J].Heart,2014,100(22):1770-1779.
[8] CUI M,WU X,MAO J,et al.T2DM Self-Management via smartphone applications:a systematic review and MetaAnalysis[J].PLoS One,2016,11(11):e166718.
[9] ALBERTI K G,ZIMMET P Z.Definition,diagnosis and classification of diabetes mellitus and its complications.Part 1:diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J].Diabet Med,1998,15(7):539-553.
[10]HIGGINS J,GREEN S.Cochrane handbook for systematic reviews of interventions version 5[M].New Jersey:Wiley-Blackwell,2011.
[11]KARDAS P,LEWANDOWSKI K,BROMURI S.Type 2diabetes patients benefit from the COMODITY12mHealth system:results of a randomised trial[J].J Med Syst,2016,40(12):259.
[12]ZHOU W,CHEN M,YUAN J,et al.Welltang-A smart phone-based diabetes management application-improves blood glucose control in Chinese People with diabetes[J].Diabetes Res Clin Pract,2016(116):105-110.
[13]BARON J S,HIRANI S,NEWMAN S P.A randomised,controlled trial of the effects of a mobile telehealth intervention on clinical and patient-reported outcomes in People with poorly controlled diabetes[J].J Telemed Telecare,2017,23(2):207-216.
[14]DRION I,PAMEIJER L R,VAN DIJK P R,et al.The effects of a mobile phone application on quality of life in patients with type 1diabetes mellitus:a randomized controlled trial[J].J Diabetes Sci Technol,2015,9(5):1086-1091.
[15]KIRWAN M,VANDELANOTTE C,FENNING A,et al.Diabetes self-management smartphone application for adults with type 1diabetes:randomized controlled trial[J].J Med Internet Res,2013,15(11):e235.
[16]NAGREBETSKY A,LARSEN M,CRAVEN A,et al.Stepwise self-titration of oral glucose-lowering medication using a mobile telephone-based telehealth platform in type 2diabetes:a feasibility trial in primary care[J].J Diabetes Sci Technol,2013,7(1):123-134.
[17]QUINN C C,SHARDELL M D,TERRIN M L,et al.Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control[J].Diabetes Care,2011,34(9):1934-1942.
[18]LIM S,KANG S M,SHIN H,et al.Improved glycemic control without hypoglycemia in elderly diabetic patients using the ubiquitous healthcare service,a new medical information system[J].Diabetes Care,2011,34(2):308-313.
[19]NOH J H,CHO Y J,NAM H W,et al.Web-based comprehensive information system for self-management of diabetes mellitus[J].Diabetes Technol Ther,2010,12(5):333-337.
[20]ISTEPANIAN R S,ZITOUNI K,HARRY D A,et al.Evaluation of a mobile phone telemonitoring system for glycaemic control in patients with diabetes[J].J Telemed Telecare,2009,15(3):125-128.
[21]LIM S,KANG S M,KIM K M,et al.Multifactorial intervention in diabetes care using real-time monitoring and tailored feedback in type 2diabetes[J].Acta Diabetol,2016,53(2):189-198.
[22]BEE Y M,BATCAGAN-ABUEG A P,CHEI C,et al.A smartphone application to deliver a Treat-to-Target insulin titration algorithm in Insulin-Naive patients with type2diabetes:apilot randomized controlled trial[J].Diabetes Care,2016,39(10):E174-176.
[23]KLEINMAN N J,SHAH A,SHAH S,et al.Impact of the gather mHealth system on a1C:primary results of a multisite randomized clinical trial among people with type2diabetes in India[J].Diabetes Care,2016,39(10):E169-170.
[24]WAKI K,FUJITA H,UCHIMURA Y,et al.DialBetics:A novel smartphone-based self-management support system for type 2diabetes patients[J].J Diabetes Sci Technol,2014,8(2):209-215.
[25]QUINN C C,CLOUGH S S,MINOR J M,et al.WellDoc Mobile diabetes management randomized controlled trial:Change in clinical and behavioral outcomes and patient and physician satisfaction[J].Diab Technol Therap,2008,10(3):160-168.
[26]KATALENICH B,SHI L,LIU S,et al.Evaluation of a remote monitoring system for diabetes control[J].Clin Ther,2015,37(6):1216.
[27]KARHULA T,VUORINEN A L,RAAPYSJARVI K,et al.Telemonitoring and mobile phone-based health coaching among finnish diabetic and heart disease patients:randomized controlled trial[J].J Med Internet Res,2015,17(6):e153.
[28]张斌.移动APP应用对2型糖尿病患者自我管理的辅助疗效研究[J].中国卫生产业,2016,13(23):78-80.
[29]乔娟,郝彦斐,燕增奎.基于智能手机的青中年2型糖尿病患者健康管理的效果观察[J].医疗卫生装备,2014,35(12):73-75.
[30]王朋朋,应燕萍,高忠兰,等.APP软件在2型糖尿病伴高血压出院患者延续护理中的应用[J].海南医学,2016,27(12):2057-2059,2060.
[31]HOLMEN H,TORBJORNSEN A,WAHL A K,et al.A Mobile health intervention for Self-Management and lifestyle change for persons with type 2diabetes,part 2:oneYear results from the Norwegian randomized controlled trial RENEWING HEALTH[J].JMIR Mhealth Uhealth,2014,2(4):e57.
[32]ORSAMA A L,LAHTEENMAKI J,HARNO K,et al.Active assistance technology reduces glycosylated hemoglobin and weight in individuals with type 2diabetes:results of a theory-based randomized trial[J].Diabetes Technol Ther,2013,15(8):662-669.
[33]RODRIGUEZ-IDIGORAS M I,SEPULVEDA-MUNOZ J A,MARTINEZ-GONZALEZ J L,et al.Telemedicine influence on the follow-up of type 2diabetes patients[J].Diabetes Technol Ther,2009,11(7):431-437.
[34]HSU W C,LAU K H,HUANG R,et al.Utilization of a Cloud-Based diabetes management program for insulin initiation and titration enables collaborative decision making between healthcare providers and patients[J].Diabetes Technol Ther,2016,18(2):59-67.
[35]YOO H J,PARK M S,KIM T N,et al.A ubiquitous chronic disease care system using cellular phones and the Internet[J].Diabetic Med,2009,26(6):628-635.
[36]CHARPENTIER G,BENHAMOU P Y,DARDARI D,et al.The diabeo software enabling individualized insulin dose adjustments combined with telemedicine support improves HbA1cin poorly controlled type 1diabetic patients:a 6-month,randomized,open-label,parallel-group,multicenter trial(TeleDiab 1study)[J].Diabetes Care,2011,34(3):533-539.
[37]ZHANG Y,HU G,YUAN Z,et al.Glycosylated hemoglobin in relationship to cardiovascular outcomes and death in patients with type 2diabetes:a systematic review and meta-analysis[J].PLoS One,2012,7(8):e42551.
[38]宋丹,徐土珍,刘玉慧,等.动机性访谈对2型糖尿病患者自我管理影响的meta分析[J].中华护理杂志,2014,49(9):1040-1045.
[39]PIBERNIK-OKANOVIC M,PRASEK M,POLJICANINFILIPOVIC T,et al.Effects of an empowerment-based psychosocial intervention on quality of Life and metabolic control in type 2 diabetic patients[J].Patient Educ Couns,2004,52(2):193-199.
[40]宋欢,高明霞,柳韦华.电话随访对糖尿病患者血糖控制效果的Meta分析[J].中国实用护理杂志,2017,33(8):627-633.