Effect of nurse-led randomised control trials on cardiovascular risk factors and HbA1c in diabetes patients: A meta-analysis

被引:22
作者
Daly, Barbara [1 ]
Tian, Catherine Jia Lin [2 ]
Scragg, Robert Keith Rhodes [3 ]
机构
[1] Univ Auckland, Sch Nursing, Fac Med & Hlth Sci, Private Bag, Auckland, New Zealand
[2] Univ Auckland, Fac Med & Hlth Sci, Auckland, New Zealand
[3] Univ Auckland, Sch Populat Hlth, Epidemiol & Biostat, Auckland, New Zealand
关键词
Meta-analysis; Diabetes management; Nurse-led clinical trials; HbA1c; Cardiovascular; Smoking cessation; SELF-MANAGEMENT SUPPORT; GLYCEMIC CONTROL; BLOOD-PRESSURE; GLUCOSE CONTROL; FOLLOW-UP; COORDINATED INTERVENTION; DELIVERED INTERVENTION; CARE; CHOLESTEROL; PEOPLE;
D O I
10.1016/j.diabres.2017.07.019
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
A systematic review and meta-analysis identified 42 randomised control trials comparing a nurse-led intervention with 'usual care' to quantify their effect on glycated haemoglobin (HbA1c) and major cardiovascular risk factors in diabetes patients. All relevant databases were systematically searched for publications to February 2016: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE and Cumulative Index to Nursing & Allied Health Literature (CINAHL). The 42 trials recruited 9955 diabetes patients (5022 randomised to intervention and 4933 to 'usual care'). For patients receiving the nurse-led intervention, compared with 'usual care', there were small but significant mean reductions for HbA1c [-0.28%; 95% CI -0.38%, -0.18%; p-value < 0.0001, n = 6920] and serum triglyceride levels [-0.27 mmol/L; 95% CI -0.49, -0.06; p = 0.01, n = 1169], and a greater proportion of patients stopped smoking [risk ratio = 2.70; 95% CI 1.35, 5.43; p = 0.005, n = 1890 patients]. Mean reductions for systolic [-1.84 mmHg; 95% CI -3.97, -0.10; p = 0.06, 4241 patients] and diastolic [-0.95 mmHg; 95% CI -2.15, -0.25; p = 0.12, 3811 patients] blood pressures trended towards significance. There were no significant mean reductions for body mass index or serum cholesterol. Nurse-led interventions produced greater improvements than 'usual care' for HbA1c, serum triglyceride and smoking cessation and support an increased independent role for nurses in diabetes management. (C) 2017 Elsevier B.V. All rights reserved.
引用
收藏
页码:187 / 199
页数:13
相关论文
共 76 条
[1]   Blood pressure targets for hypertension in people with diabetes mellitus [J].
Agustin Arguedas, Jose ;
Leiva, Viriam ;
Wright, James M. .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2013, (10)
[2]   Statistics Notes - Interaction revisited: the difference between two estimates [J].
Altman, DG ;
Bland, JM .
BMJ-BRITISH MEDICAL JOURNAL, 2003, 326 (7382) :219-219
[3]  
[Anonymous], NEW ENGL J MED
[4]  
[Anonymous], COCHRANE HDB SYSTEMA
[5]   Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins [J].
Baigent, C ;
Keech, A ;
Kearney, PM ;
Blackwell, L ;
Buck, G ;
Pollicino, C ;
Kirby, A ;
Sourjina, T ;
Peto, R ;
Collins, R ;
Simes, J .
LANCET, 2005, 366 (9493) :1267-1278
[6]   Effectiveness of general practice based, practice nurse led telephone coaching on glycaemic control of type 2 diabetes: the Patient Engagement And Coaching for Health (PEACH) pragmatic cluster randomised controlled trial [J].
Blackberry, Irene D. ;
Furler, John S. ;
Best, James D. ;
Chondros, Patty ;
Vale, Margarite ;
Walker, Christine ;
Dunning, Trisha ;
Segal, Leonie ;
Dunbar, James ;
Audehm, Ralph ;
Liew, Danny ;
Young, Doris .
BMJ-BRITISH MEDICAL JOURNAL, 2013, 347
[7]   A basic introduction to fixed-effect and random-effects models for meta-analysis [J].
Borenstein, Michael ;
Hedges, Larry V. ;
Higgins, Julian P. T. ;
Rothstein, Hannah R. .
RESEARCH SYNTHESIS METHODS, 2010, 1 (02) :97-111
[8]   Risk factors for vascular disease in patients with diabetes [J].
Brown, WV .
DIABETES OBESITY & METABOLISM, 2000, 2 :11-18
[9]   Intervention study for smoking cessation in diabetic patients -: A randomized controlled trial in both clinical and primary care settings [J].
Canga, N ;
De Irala, J ;
Vara, E ;
Duaso, MJ ;
Ferrer, A ;
Martínez-González, MA .
DIABETES CARE, 2000, 23 (10) :1455-1460
[10]   Reduction of diabetes risk in routine clinical practice: are physical activity and nutrition interventions feasible and are the outcomes from reference trials replicable? A systematic review and meta-analysis [J].
Cardona-Morrell, Magnolia ;
Rychetnik, Lucie ;
Morrell, Stephen L. ;
Espinel, Paola T. ;
Bauman, Adrian .
BMC PUBLIC HEALTH, 2010, 10