Purpose

The objectives of this umbrella review were to describe various aspects of diabetes self-management education and support (DSMES)-related interventions and their effect on clinical, behavioral, and psychosocial outcomes among children and young adults with type 1 diabetes (T1DM) and identify gaps in current DSMES-related research.

Methods

An umbrella review of systematic reviews on DSMES interventions was conducted in accordance with the PRISMA 2009 statement. Four international medical databases were searched for eligible review articles published in English in the last 10 years that dealt with children and youths with T1DM and were conducted in accordance with a priori protocol.

Results

Out of the 234 citations screened, only 8 systematic reviews representing 166 studies were considered eligible for further analysis. Glycemic management (A1C) is the most common outcome variable (108 studies). Common behavioral and psychosocial outcome variables examined are episodes of hypoglycemia (27 studies) and diabetic ketoacidosis (21 studies) and self-care behavior and generic quality of life (20 studies each). Several gaps in DSMES-related research studies are identified, including uneven geographical distribution of study population, methodological weaknesses in study designs, missing important outcome variables, use of nonstandardized assessment tools, and lack of assessment of the sustainability of effects.

Conclusion

The effects of DSMES interventions on clinical, behavioral, and psychosocial outcomes are varied. The heterogeneity of implementation and evaluation makes it difficult to draw clear conclusions about elements of DSMES that are most effective. There is a need for long-term assessment of the psychosocial and behavioral outcomes using validated and generalizable instruments.

中文翻译：

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糖尿病自我管理教育和支持改善 1 型糖尿病儿童和青少年的预后：系统评价的总体评价

目的

本综述的目的是描述糖尿病自我管理教育和支持 (DSMES) 相关干预措施的各个方面及其对患有 1 型糖尿病 (T1DM) 的儿童和青少年的临床、行为和社会心理结果的影响，并确定当前 DSMES 相关研究的空白。

方法

根据 PRISMA 2009 声明，对 DSMES 干预措施的系统评价进行了综合评价。搜索了四个国际医学数据库，以查找过去 10 年中以英语发表的符合条件的评论文章，这些文章涉及患有 T1DM 的儿童和青少年，并按照先验方案进行。

结果

在筛选的 234 篇引文中，只有代表 166 项研究的 8 篇系统评价被认为符合进一步分析的条件。血糖管理 (A1C) 是最常见的结果变量（108 项研究）。检查的常见行为和心理社会结果变量是低血糖发作（27 项研究）和糖尿病酮症酸中毒（21 项研究）以及自我保健行为和一般生活质量（各 20 项研究）。确定了 DSMES 相关研究中的几个差距，包括研究人群的地理分布不均匀、研究设计中的方法学缺陷、缺少重要的结果变量、使用非标准化评估工具以及缺乏对效果可持续性的评估。

结论

DSMES 干预对临床、行为和社会心理结果的影响各不相同。实施和评估的异质性使得很难就最有效的 DSMES 要素得出明确的结论。有必要使用经过验证的通用工具对心理社会和行为结果进行长期评估。