Interventions to improve patients’ compliance with therapies aimed at lowering glycated hemoglobin (HbA1c) in type 1 diabetes: systematic review and meta-analyses of randomized controlled clinical trials of psychological, telecare, and educational interventions
Identifieur interne : 000037 ( Main/Exploration ); précédent : 000036; suivant : 000038Interventions to improve patients’ compliance with therapies aimed at lowering glycated hemoglobin (HbA1c) in type 1 diabetes: systematic review and meta-analyses of randomized controlled clinical trials of psychological, telecare, and educational interventions
Auteurs : Luciana Verçoza Viana [Brésil] ; Marilia Brito Gomes [Brésil] ; Lenita Zajdenverg [Brésil] ; Elizabeth Joao Pavin [Brésil] ; Mirela Jobim Azevedo [Brésil]Source :
- Trials [ 1745-6215 ] ; 2016.
Abstract
Brazilian records on glycemic control in patients with type 1 diabetes show treatment efficacy. Poor patient adherence to therapeutic proposals influences these results and can be associated with social, psychological, and economic aspects, besides others factors. The aim of this study was to evaluate the efficacy of psychological, telecare, and educational interventions to improve treatment compliance among patients with type 1 diabetes. Compliance was assessed indirectly using reduction of glycated hemoglobin (HbA1c) as the principal outcome measure.
Systematic review and meta-analyses of randomized controlled clinical trials (RCTs) were performed using Medline, Embase, Cochrane and Scopus databases up to April 2015. The following medical subject headings were used: Diabetes Mellitus, Type 1, Patient Compliance or Adherence, Hemoglobin A, glycated, and Randomized Controlled Trial. The principal outcome was change in HbA1c between baseline and follow-up. Where appropriate, trials were combined in meta-analysis using fixed effects models.
From 191 articles initially identified, 57 were full text reviewed, and 19 articles met the inclusion criteria providing data from 1782 patients (49.4 % males, age 18 years). The RCTs (2 to 24 months in duration) were divided into four groups according to type of intervention: psychology (seven studies; 818 patients), telecare (six studies; 494 patients); education (five studies; 349 patients), and psychoeducation (one study; 153 patients). All studies reported some type of adherence measurement of the interventions. Decrease in HbA1c was observed after psychology (MD −0.310; 95 % CI, −0.599 to −0.0210,
Psychological approaches to improve adherence to diabetes care treatment modestly reduced HbA1c in patients with type 1 diabetes; telecare and education interventions did not change glycemic control. However, the limited number of studies included as well as their methodological quality should be taken into account.
The online version of this article (doi:10.1186/s13063-016-1207-6) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s13063-016-1207-6
PubMed: 26888087
PubMed Central: 4758163
Affiliations:
- Brésil
- Rio Grande do Sul, État de Rio de Janeiro, État de São Paulo
- Campinas, Porto Alegre, Rio de Janeiro
- Université d'État de Campinas, Université fédérale du Rio Grande do Sul
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Le document en format XML
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sortKey="Gomes, Marilia Brito" sort="Gomes, Marilia Brito" uniqKey="Gomes M" first="Marilia Brito" last="Gomes">Marilia Brito Gomes</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil</nlm:aff><country xml:lang="fr">Brésil</country><wicri:regionArea>Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Rio de Janeiro</wicri:regionArea><placeName><settlement type="city">Rio de Janeiro</settlement><region type="state">État de Rio de Janeiro</region></placeName></affiliation></author><author><name sortKey="Zajdenverg, Lenita" sort="Zajdenverg, Lenita" uniqKey="Zajdenverg L" first="Lenita" last="Zajdenverg">Lenita Zajdenverg</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Internal Medicine Department, Diabetes Division, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil</nlm:aff><country 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when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000138</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000138</idno><idno type="wicri:Area/Pmc/Curation">000138</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000138</idno><idno type="wicri:Area/Pmc/Checkpoint">000018</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000018</idno><idno type="wicri:Area/Ncbi/Merge">000C63</idno><idno type="wicri:Area/Ncbi/Curation">000C63</idno><idno type="wicri:Area/Ncbi/Checkpoint">000C63</idno><idno type="wicri:Area/Main/Merge">000037</idno><idno type="wicri:Area/Main/Curation">000037</idno><idno type="wicri:Area/Main/Exploration">000037</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Interventions to improve patients’ compliance with therapies aimed at lowering glycated hemoglobin (HbA1c) in type 1 diabetes: systematic review and meta-analyses of randomized controlled clinical trials of psychological, telecare, and educational interventions</title><author><name sortKey="Viana, Luciana Vercoza" sort="Viana, Luciana Vercoza" uniqKey="Viana L" first="Luciana Verçoza" last="Viana">Luciana Verçoza Viana</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, RS Brazil</nlm:aff><orgName type="university">Université fédérale du Rio Grande do Sul</orgName><country>Brésil</country><placeName><settlement type="city">Porto Alegre</settlement><region type="state">Rio Grande do Sul</region></placeName></affiliation></author><author><name sortKey="Gomes, Marilia Brito" sort="Gomes, Marilia Brito" uniqKey="Gomes M" first="Marilia Brito" last="Gomes">Marilia Brito Gomes</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil</nlm:aff><country xml:lang="fr">Brésil</country><wicri:regionArea>Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Rio de Janeiro</wicri:regionArea><placeName><settlement type="city">Rio de Janeiro</settlement><region type="state">État de Rio de Janeiro</region></placeName></affiliation></author><author><name sortKey="Zajdenverg, Lenita" sort="Zajdenverg, Lenita" uniqKey="Zajdenverg L" first="Lenita" last="Zajdenverg">Lenita Zajdenverg</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Internal Medicine Department, Diabetes Division, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil</nlm:aff><country xml:lang="fr">Brésil</country><wicri:regionArea>Internal Medicine Department, Diabetes Division, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro</wicri:regionArea><placeName><settlement type="city">Rio de Janeiro</settlement><region type="state">État de Rio de Janeiro</region></placeName></affiliation></author><author><name sortKey="Pavin, Elizabeth Joao" sort="Pavin, Elizabeth Joao" uniqKey="Pavin E" first="Elizabeth Joao" last="Pavin">Elizabeth Joao Pavin</name><affiliation wicri:level="4"><nlm:aff id="Aff4">Department of Clinical Medicine, Universidade Estadual de Campinas, Campinas, Brazil</nlm:aff><country xml:lang="fr">Brésil</country><wicri:regionArea>Department of Clinical Medicine, Universidade Estadual de Campinas, Campinas</wicri:regionArea><orgName type="university">Université d'État de Campinas</orgName><placeName><settlement type="city">Campinas</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Azevedo, Mirela Jobim" sort="Azevedo, Mirela Jobim" uniqKey="Azevedo M" first="Mirela Jobim" last="Azevedo">Mirela Jobim Azevedo</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003 Porto Alegre, RS Brazil</nlm:aff><orgName type="university">Université fédérale du Rio Grande do Sul</orgName><country>Brésil</country><placeName><settlement type="city">Porto Alegre</settlement><region type="state">Rio Grande do Sul</region></placeName></affiliation></author></analytic><series><title level="j">Trials</title><idno type="eISSN">1745-6215</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Brazilian records on glycemic control in patients with type 1 diabetes show treatment efficacy. Poor patient adherence to therapeutic proposals influences these results and can be associated with social, psychological, and economic aspects, besides others factors. The aim of this study was to evaluate the efficacy of psychological, telecare, and educational interventions to improve treatment compliance among patients with type 1 diabetes. Compliance was assessed indirectly using reduction of glycated hemoglobin (HbA1c) as the principal outcome measure.</p></sec><sec><title>Methods</title><p>Systematic review and meta-analyses of randomized controlled clinical trials (RCTs) were performed using Medline, Embase, Cochrane and Scopus databases up to April 2015. The following medical subject headings were used: Diabetes Mellitus, Type 1, Patient Compliance or Adherence, Hemoglobin A, glycated, and Randomized Controlled Trial. The principal outcome was change in HbA1c between baseline and follow-up. Where appropriate, trials were combined in meta-analysis using fixed effects models.</p></sec><sec><title>Results</title><p>From 191 articles initially identified, 57 were full text reviewed, and 19 articles met the inclusion criteria providing data from 1782 patients (49.4 % males, age 18 years). The RCTs (2 to 24 months in duration) were divided into four groups according to type of intervention: psychology (seven studies; 818 patients), telecare (six studies; 494 patients); education (five studies; 349 patients), and psychoeducation (one study; 153 patients). All studies reported some type of adherence measurement of the interventions. Decrease in HbA1c was observed after psychology (MD −0.310; 95 % CI, −0.599 to −0.0210, <italic>P</italic> = 0.035) but not after telecare (MD −0.124 %; 95 % CI, −0.268, 0.020; <italic>P</italic> = 0.090) or educational (MD −0.001; 95 % CI, −0.202, 0.200; <italic>P</italic> = 0.990) interventions.</p></sec><sec><title>Conclusion</title><p>Psychological approaches to improve adherence to diabetes care treatment modestly reduced HbA1c in patients with type 1 diabetes; telecare and education interventions did not change glycemic control. However, the limited number of studies included as well as their methodological quality should be taken into account.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s13063-016-1207-6) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="De Boer, Ih" uniqKey="De Boer I">IH de Boer</name></author><author><name sortKey="Sun, W" uniqKey="Sun W">W Sun</name></author><author><name sortKey="Cleary, Pa" uniqKey="Cleary P">PA Cleary</name></author><author><name sortKey="Lachin, Jm" uniqKey="Lachin J">JM Lachin</name></author><author><name sortKey="Molitch, Me" uniqKey="Molitch M">ME Molitch</name></author><author><name sortKey="Steffes, Mw" uniqKey="Steffes M">MW Steffes</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name 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Azevedo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gomes, Mb" uniqKey="Gomes M">MB Gomes</name></author><author><name sortKey="Coral, M" uniqKey="Coral M">M Coral</name></author><author><name sortKey="Cobas, Ra" uniqKey="Cobas R">RA Cobas</name></author><author><name sortKey="Dib, Sa" uniqKey="Dib S">SA Dib</name></author><author><name sortKey="Canani, Lh" uniqKey="Canani L">LH Canani</name></author><author><name sortKey="Nery, M" uniqKey="Nery M">M Nery</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Brésil</li></country><region><li>Rio Grande do Sul</li><li>État de Rio de Janeiro</li><li>État de São Paulo</li></region><settlement><li>Campinas</li><li>Porto Alegre</li><li>Rio de Janeiro</li></settlement><orgName><li>Université d'État de Campinas</li><li>Université fédérale du Rio Grande do Sul</li></orgName></list><tree><country name="Brésil"><region name="Rio Grande do Sul"><name sortKey="Viana, Luciana Vercoza" sort="Viana, Luciana Vercoza" uniqKey="Viana L" first="Luciana Verçoza" last="Viana">Luciana Verçoza Viana</name></region><name sortKey="Azevedo, Mirela Jobim" sort="Azevedo, Mirela Jobim" uniqKey="Azevedo M" first="Mirela Jobim" last="Azevedo">Mirela Jobim Azevedo</name><name sortKey="Gomes, Marilia Brito" sort="Gomes, Marilia Brito" uniqKey="Gomes M" first="Marilia Brito" last="Gomes">Marilia Brito Gomes</name><name sortKey="Pavin, Elizabeth Joao" sort="Pavin, Elizabeth Joao" uniqKey="Pavin E" first="Elizabeth Joao" last="Pavin">Elizabeth Joao Pavin</name><name sortKey="Zajdenverg, Lenita" sort="Zajdenverg, Lenita" uniqKey="Zajdenverg L" first="Lenita" last="Zajdenverg">Lenita Zajdenverg</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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