| Objective To systematic review the effect of diabetes education in China;to explore the gaps of Chinese diabetes education in the design,implementation and evaluation,and to provide theoretical evidence for standardized diabetes education program.Methods Chinese language articles were searched for the terms Diabetes and Education,from Chongqing Weipu(1989-2008.7) and CNKI(1994-2008.7) database.English language articles were searched for terms Education,and China or Chinese from National Science and Technology Library(NSTL),PubMed and Cochrane Library,Diabetes Educator and Diabetes Care.The search was conducted by information professionals.Articles were included in the review if the participants lived in mainland China and were diagnosed with diabetes;original articles;published on the journal of statistics source;randomized controlled trials;HbA1c or behavior change should be measured in the evaluation;and the duration should be no less than 3 months.The method quality of the trials was evaluated and the participants,educators, contents,methods,outcomes measurement and effects were systematically reviewed.The impact on body mass index(BMI),glucose metabolism,lipid metabolism,anxiety and depression score(SAS and SAD) were analyzed by meta-analysis.Standard deviation of weighted mean(WMD) and 95%confidence intervals(CI) were calculatedResults1.A total of f 27 randomized controlled trials of 3031 initially identified articles met selection criteria.Internal validity was frequently threatened by 1)lack of blinding of the assessors,2) lack of detail on allocation concealment,and 3) lack of intention-to-treat(ITT),4) deficits in the reliability and validity of the instruments used to measure knowledge and behavior change.2.Positive effects of diabetes education on knowledge,behavior change and quality of life were demonstrated in studies with short follow-up(3～6 months).The WMD and 95%CI of BMI,fasting glucose,2 hours postprandial blood glucose,glycosylated hemoglobin, cholesterol,triglycerides of intervention group and control group were respectively -0.67(-0.95,-0.38),-0.75(-0.89,-0.61),-1.35(-1.56,-1.14), -0.66(-0.78,-0.54),-0.79(-0.93,-0.65),-0.68(-0.77,-0.59) in 3 months; -0.85(-1.06,-0.53),-0.76(-0.92,-0.61),-2.09(-2.26,-1.93),-0.43(-0.53, -0.33),-0.44(-0.55,-0.33),-0.60(-0.70,-0.51) in 6 months;and -0.46 (-0.88,-0.04),-1.34(-1.65,-1.03),-1.40(-1.89,-0.90),-1.37(-1.54, -1.19),-0.73(-0.92,-0.53),-0.80(-0.96,-0.64) in 12 months;the WMD and 95%CI of SAS and SDS were -4.29(-5.63,-2.95) and -4.80 (-6.02,-3.58) in 3 months.There were significant differences between intervention and control group(p＜0.05 or p＜0.01).3.67%of the participants were from inpatient and outpatient,11% were from community,7%from rural,63%were type 2 diabetes;The educators included doctors(59%),nurses(56%),dietitians(22%), psychologists(19%) and patients(7%),only 15%were conducted by the multidisplinary team;although the content was comprehensive,22% had written curriculums;The most popular methods was class teaching(89%),22%combined with psychological intervention and 4% combined with behavior intervention;74%of studies observed the effectiveness of 3～6 months;the outcomes measurement included glycemic control(89%),behavior change((52%),improved health status(44%) and learning(40).Conclusion1.As a whole method quality of included studies was class B. Selection bias,performance bias and detection bias were exsited.2.Evidence supports the effect of diabetes education:it can increase patients' knowledge,promote behavior change,significantly improve the patient's BMI,glucose and lipid control,anxiety and depression status.3.There were still some gaps in the literature:the samples were mainly from the outpatient and inpatient,community and rural patients were received less concern;lack of certificated diabetes adductors,lack of real team management;almost all education were didactic presentation;the intervention and follow-up period is relatively short, long-term effects of diabetes education was unknown.
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