强化糖尿病教育与常规糖尿病教育比较预防糖尿病足溃疡的系统评价_《中国循证医学杂志》

作者：

 何继东 , 张兰 , 刘莉 , 朱毓江

雅安市第二人民医院内分泌科（雅安 625000）;

关键词：

强化糖尿病教育糖尿病足溃疡系统评价 Meta分析随机对照试验

DOI：

10.7507/1672-2531.20130251

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价强化糖尿病教育与常规糖尿病教育比较预防糖尿病足溃疡的有效性。
方法　计算机检索CENTRAL（2013年第1期）、PubMed（1978～2013）、EMbase（1978～2013）、VIP（1989～2013）和WanFang Data（1980～2013），同时手工检索相关会议论文集并追溯纳入文献的参考文献，全面收集全世界关于强化糖尿病教育与常规糖尿病教育比较预防糖尿病足溃疡的随机对照试验。由2位研究者独立按照纳入与排除标准筛选文献、提取资料和评价质量后，采用RevMan 5.2进行Meta分析。
结果　最终纳入12个研究，1 841例患者。Meta分析结果显示：强化糖尿病教育组糖尿病足溃疡发生率低于常规糖尿病教育组，其差异有统计学意义［RR=0.51，95%CI（0.30，0.84），P=0.008］；但两组糖尿病足截肢率差异无统计学意义［OR=0.54，95%CI（0.17，1.67），P=0.28］；强化糖尿病教育组糖尿病知识积分高于常规糖尿病教育组，其差异有统计学意义［MD=7.32，95%CI （3.57，11.06），P=0.000 1］。
结论　现有证据表明：强化糖尿病教育较常规糖尿病教育能更有效地减少糖尿病足溃疡的发生率，但上述结论尚需开展更多高质量的研究加以验证。

引用本文： 何继东,张兰,刘莉,朱毓江. 强化糖尿病教育与常规糖尿病教育比较预防糖尿病足溃疡的系统评价. 中国循证医学杂志, 2013, 13(12): 1470-1474. doi: 10.7507/1672-2531.20130251 复制

1.	Boulton AJ, Vileikyte L, Ragnarson-Tennvall, et al. The global burden of diabetic foot disease. Lancet, 2005, 366(9498): 1719-1724.
2.	Bouhon AJ. The diabetic foot: a global view. Diabetes Metab Res Rev, 2000, 16(s1): s2-s5．.
3.	Boulton AJ. The diabetic foot: from art to science. Diabetologia, 2004, 47(8): 1343-1353.
4.	Lavery LA, Armstrong DG, Wunderlich RP, et al. Risk factors for foot infections in individuals with diabetes. Diabetes Care, 2006, 29(6): 1288-1293.
5.	Brownrigg JR, Davey J, Holt PJ, et al. The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis. Diabetologia, 2012, 55(11): 2906-2912.
6.	Rena R, James E, Michael G, et al. Behavioral science research in diabetes lifestyle change related to obesity,eating behavior,and physical activity. Diabete Care, 2001, 24(1): 117-123.
7.	Cgnthia F. Preventive care of the diabetic foot. Nurs Clin North Am, 2001, 36(2): 303-306.
8.	Reiber GE, Pecoraro RE, Koepsell TD. Risk factors for amputation in patients with diabetes mellitus. A case-control reprot. Ann lntern Med, 1992, 117(2): 97-105.
9.	朱禧星. 糖尿病. 见: 陈灏珠, 主编. 实用内科学. 第12版. 北京: 人民卫生出版社, 2002: 958.
10.	The Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011].Available from: http://www.cochrane.org/.htm.
11.	范丽凤, 李峥, 陆菊明, 等. 强化教育干预对糖尿病足预防的中远期效果. 中华老年多器官疾病杂志, 2006, 5(1): 24-29.
12.	刘正广, 笱晓葵, 刘颜, 等. 强化家庭预防性健康教育对老年糖尿病足溃疡的预防效果评价. 中国实用内科杂志, 2008, 28(2): 68-69.
13.	黄萍, 黄佳敏, 李桂蓉, 等. 糖尿病知识强化教育对预防糖尿病足的效果观察. 现代预防医学, 2009, 36(15): 2879-2881.
14.	黄雪花. 糖尿病教育对预防糖尿病足发生的影响. 中外健康文摘, 2010, 33(7): 362.
15.	林小敏, 卫建宁. 个体化教育干预措施对预防糖尿病足的意义. 医学新知杂志, 2010, 20(3): 212-213.
16.	Malone JM, Snyder M, Anderson G, et al. Prevention of amputation by diabetic education. The American Journal of Surgery, 1989, 158(6): 520-524.
17.	Barth R, Campbell LV, Allen S, et al. Intensive education improves knowledge, compliance and foot problems in type 2 diabetes. Diabetic Medicine, 1991, 8(2): 111-117.
18.	Kruger S, Guthrie D. Foot care: knowledge retention and self-care practices. The Diabetes Educator, 1992, 18(6): 487-490.
19.	Rönnemaa T, Hämäläinen H, Toikka T, et al. Evaluation of the impact of podiatrist care in the primary prevention of foot problems in diabetic subjects. Diabetes Care, 1997, 20(12): 1833-1837.
20.	Frank KI, Martin J, Bennett SJ. Self-management of foot care for patients 65 years of age or older with diabetes. Journal of The American Geriatrics Society, 2005, 53(4): S215-S215.
21.	Lincoln NB, Radford KA, Game FL, et al. Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial. Diabetologia, 2008, 51(11): 1954-1961.
22.	Cisneros LL. Evaluation of a neuropathic ulcers prevention program for patients with diabetes. Revista brasileira de fisioterapia, 2010, 14(1): 31-37.
23.	Assal JA, Albeanu A, Peter-Riesch B, et al. Cost of training a diabetes mellitus patient. Effects on the prevention of amputation. Diabete metab, 1993, 19(5 Suppl): 491.
24.	Reiber GE, Pecoraro RE, Koepsell TD. Risk factors for amputation in patients with diabetes mellitus. A case-control report. Ann lntern Med, 1992, 117(2): 97-105.

1. Boulton AJ, Vileikyte L, Ragnarson-Tennvall, et al. The global burden of diabetic foot disease. Lancet, 2005, 366(9498): 1719-1724.
2. Bouhon AJ. The diabetic foot: a global view. Diabetes Metab Res Rev, 2000, 16(s1): s2-s5．.
3. Boulton AJ. The diabetic foot: from art to science. Diabetologia, 2004, 47(8): 1343-1353.
4. Lavery LA, Armstrong DG, Wunderlich RP, et al. Risk factors for foot infections in individuals with diabetes. Diabetes Care, 2006, 29(6): 1288-1293.
5. Brownrigg JR, Davey J, Holt PJ, et al. The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis. Diabetologia, 2012, 55(11): 2906-2912.
6. Rena R, James E, Michael G, et al. Behavioral science research in diabetes lifestyle change related to obesity,eating behavior,and physical activity. Diabete Care, 2001, 24(1): 117-123.
7. Cgnthia F. Preventive care of the diabetic foot. Nurs Clin North Am, 2001, 36(2): 303-306.
8. Reiber GE, Pecoraro RE, Koepsell TD. Risk factors for amputation in patients with diabetes mellitus. A case-control reprot. Ann lntern Med, 1992, 117(2): 97-105.
9. 朱禧星. 糖尿病. 见: 陈灏珠, 主编. 实用内科学. 第12版. 北京: 人民卫生出版社, 2002: 958.
10. The Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011].Available from: http://www.cochrane.org/.htm.
11. 范丽凤, 李峥, 陆菊明, 等. 强化教育干预对糖尿病足预防的中远期效果. 中华老年多器官疾病杂志, 2006, 5(1): 24-29.
12. 刘正广, 笱晓葵, 刘颜, 等. 强化家庭预防性健康教育对老年糖尿病足溃疡的预防效果评价. 中国实用内科杂志, 2008, 28(2): 68-69.
13. 黄萍, 黄佳敏, 李桂蓉, 等. 糖尿病知识强化教育对预防糖尿病足的效果观察. 现代预防医学, 2009, 36(15): 2879-2881.
14. 黄雪花. 糖尿病教育对预防糖尿病足发生的影响. 中外健康文摘, 2010, 33(7): 362.
15. 林小敏, 卫建宁. 个体化教育干预措施对预防糖尿病足的意义. 医学新知杂志, 2010, 20(3): 212-213.
16. Malone JM, Snyder M, Anderson G, et al. Prevention of amputation by diabetic education. The American Journal of Surgery, 1989, 158(6): 520-524.
17. Barth R, Campbell LV, Allen S, et al. Intensive education improves knowledge, compliance and foot problems in type 2 diabetes. Diabetic Medicine, 1991, 8(2): 111-117.
18. Kruger S, Guthrie D. Foot care: knowledge retention and self-care practices. The Diabetes Educator, 1992, 18(6): 487-490.
19. Rönnemaa T, Hämäläinen H, Toikka T, et al. Evaluation of the impact of podiatrist care in the primary prevention of foot problems in diabetic subjects. Diabetes Care, 1997, 20(12): 1833-1837.
20. Frank KI, Martin J, Bennett SJ. Self-management of foot care for patients 65 years of age or older with diabetes. Journal of The American Geriatrics Society, 2005, 53(4): S215-S215.
21. Lincoln NB, Radford KA, Game FL, et al. Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial. Diabetologia, 2008, 51(11): 1954-1961.
22. Cisneros LL. Evaluation of a neuropathic ulcers prevention program for patients with diabetes. Revista brasileira de fisioterapia, 2010, 14(1): 31-37.
23. Assal JA, Albeanu A, Peter-Riesch B, et al. Cost of training a diabetes mellitus patient. Effects on the prevention of amputation. Diabete metab, 1993, 19(5 Suppl): 491.
24. Reiber GE, Pecoraro RE, Koepsell TD. Risk factors for amputation in patients with diabetes mellitus. A case-control report. Ann lntern Med, 1992, 117(2): 97-105.

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强化糖尿病教育与常规糖尿病教育比较预防糖尿病足溃疡的系统评价

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《中国循证医学杂志》

强化糖尿病教育与常规糖尿病教育比较预防糖尿病足溃疡的系统评价

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