基于社区卫生工作者管理下的运动干预对2型糖尿病影响的Meta分析

Background ?Patients with type 2 diabetes usually lack sufficient awareness of safe exercise and have poor exercise compliancewhich requires the management of exercise interventions by professionals to improve the health status of patients with type 2 diabetes. A strategy worth considering is the management of exercise interventions for patients by community health workers. Currentlythere is a lack of research on the management of exercise interventionsand studies on the health management of patients with type 2 diabetes usually only mention exercise without specific exercise management measures. Additionallythere is a lack of quantitative systematic reviews. Objective ?To systematically review the health effects of exercise interventions based on community health workers'?management for patients with type 2 diabetes and specific exercise intervention programs. Methods ?Eight Chinese and English databasesincluding PubMedCochrane LibraryWeb of ScienceEmbaseCNKIWanfang DataVIP and CBM were searched by computer from inception to October 172022to screen randomized controlled trials on the effects of exercise interventions based on community health workers'?management for patients with type 2 diabetesin which the intervention group adopted an exercise intervention program based on community health workers' management and the control group adopted conventional care. Literature screeningquality assessmentand data extraction were performed independently by 2 investigators. Meta-analysis was performed using RevMan 5.4 and Stata 15.1 software. Sensitivity and subgroup analyses were carried out to find sources of heterogeneity. Pre-identified subgroups were intervention duration3 months6 months>6 monthsfrequency of exercise3 times/week>3 times/weekand duration of the single exercise session≤ 30 min/session>30 min/session. Results ?A total of 1 079 subjects from 11 articles were finally included in this reviewof which 550 were in the intervention group and 529 in the control group. The results of the Meta-analysis revealed that the exercise interventions based on community health workers'?management were more effective than the control groups in reducing glycated hemoglobinMD=-1.0795%CI=-1.31 to -0.83P<0.000 01fasting blood glucoseMD=-1.2695%CI=-1.57 to -0.96 P<0.000 012-hour plasma glucoseMD=-1.4795%CI=-1.90 to -1.04P<0.000 01total cholesterolMD=- 1.0295%CI=-1.52 to -0.51P<0.000 1low-density lipoprotein MD=-0.6295%CI=-0.87 to -0.37and P<0.000 01 and triglyceride levelsMD=-0.7195%CI=-1.13 to -0.28P=0.001whereas there was no significant difference in the improvement of high-density lipoprotein MD=0.0995%CI=-0.02 to 0.21P=0.11. Subgroup analysis showed more significant improvements in total cholesterol with exercise frequency of more than three times/week compared with three times/weekP=0.02improvement in 2-hour plasma glucose was more significant with >30 min/session compared with ≤ 30 min/sessionP=0.001single exercise session of three months duration showed more significant improvements in glycated hemoglobinP<0.000 01 and triglyceridesP=0.008 compared with duration of six months and longer. Egger's test indicated that glycated hemoglobinP=0.34and fasting blood glucoseP=0.281 did not show any significant publication bias. The quality of evidence evaluation demonstrated that glycated hemoglobin and fasting blood glucose were low-level evidenceand 2-hour plasma glucose and lipid-related outcomes were very low-level evidence. Conclusion ?Exercise interventions based on community health workers'?management could significantly improve blood glucose and lipid levels in patients with type 2 diabetes. Community health workers are recommended to develop an exercise program based on aerobic exercise intervention of >30 min/session>3 sessions/weekand duration of ≥ 3 months in future exercise intervention management for type 2 diabetes. If the patients with type 2 diabetes mellitus have concurrent dyslipidemiait is recommended that the duration of the exercise intervention should ideally last for more than 6 months.