Educação na autogestão do diabetes em adultos com diabetes mellitus tipo 2: revisão sistemática dos efeitos na autogestão e controle glicêmico

Abstract

Background: Patients with diabetes mellitus (DM) demand high costs related to their care, therefore, programs focused on self-management behavior change then being implemented, because it is related to chronic disease outcomes. In this way, education programs to diabetes patients must be based on patient self-management, self-care, and self-efficacy that improve self-management disease. Purpose: identify the scientific evidence of intervention to modify patient’s behavior with DM type 2 and the impact in self-management disease and glycemic control. Methods: This is a systematic review, reported according to the PRISMA checklist. This review’s protocol was registered in the database International Prospective Register of Systematic Reviews (PROSPERO), CRD42020161162 and in a public open data bank Open Science Framework, DOI 10.17605/OSF.IO/Z73U2. The bases selected were: MEDLINE, EMBASE, CINAHL, Cochrane Library, and LILACS, without language restrict. Were included randomized clinical trials, with just patients diabetes type 2 with more than 18 years old, both gender, independent of glycated hemoglobin level and time with diabetes. The interventions considered were: behavioral self-management interventions which may include diet, exercise, medication or insulin control, blood glucose monitoring and participation in clinic consultations. About the comparator, just studies with a control group that does not receive a behavioral intervention. The risk of bias was assessed using an evaluating tool of Cochrane, the assess the quality of evidence was based on Grading of Recommendation, Assessment, Development, and Evaluation (GRADE). Outcomes: Were analyzed 2615 studies, in the end 27 studies were included in the analyses. Among all studies assessed, 12 there is a significant difference between groups to self- management outcome, while for the glycated hemoglobin outcome just 5 studies there is a significant difference between groups. The risk of bias was considered high in most of the studies and the quality of evidence was assessed as very low. Due to the different evaluating methods used in the studies, a meta-analysis could not be performed. Conclusion: Some interventions based on self-management education improved self-management and glycemic control. However, the few and with low variety of interventions, the high risk of bias and low quality of evidence limit the conclusion. Therefore, new studies are necessary to assess the intervention's evidence in self-management and glycemic control.