哮喘联盟

   摘要
   目的：比较高强度和低强度戒烟干预对1型或2型糖尿病患者戒烟效果的影响。
   设计：对有关戒烟干预的随机试验进行系统综述和meta-分析。搜索截至2013年9月以下电子数据库：MEDLINE, EMBASE, CINAHL和PsycINFO。本研究还对注册试验和已查找试验的参考文献进行了回顾，以增加搜索范围。引文和文章全文由两位评论者进行筛选。采用随机-效应Mantel-Haenszel模型对数据进行整理。
   设置：初级、二级及三级护理。
   受试者：1型或2型成人糖尿病患者。
   干预：戒烟干预或药物治疗（高强度干预）与常规护理、咨询或选择性药物治疗（低强度干预）进行比较。
   结局指标：主要终点是生化检查验证的戒烟。次要终点是不良事件和对血糖控制的影响。我们对自报戒烟结果进行综合分析。
   结果：我们筛选了1783篇引文，对7篇文章中报道的8项试验（872位受试者）进行回顾分析。所有的试验周期均为6个月。三项研究为通过药物戒烟治疗。与低强度戒烟干预相比，高强度干预的生化验证戒烟率为1.32 (95%可信区间：0.23 -7.43) ，且存在显著异质性(I(2)=76%)。只有一项试验报道了血糖控制的检测结果。
   结论：糖尿病患者中缺乏高强度戒烟干预的疗效证据。迄今试验中检测的高强度干预策略包括了针对一般人群的干预措施，并增加了糖尿病增加风险的特殊教育。未来的研究应该聚焦在至少超过1年的多组分戒烟干预上，并评估其对血糖控制的影响。
 

（刘国梁 审校）
BMJ Open. 2014 Mar 6;4(3):e004107. doi: 10.1136/bmjopen-2013-004107.

 

Smoking cessation in adults with diabetes: a systematic review and meta-analysis of data from randomised controlled trials.

Nagrebetsky A1, Brettell R, Roberts N, Farmer A.
 

Abstract
OBJECTIVES: To evaluate the effects of more intensive smoking cessation interventions compared to less intensive interventions on smoking cessation in people with type 1 or type 2 diabetes.
DESIGN: A systematic review and meta-analysis of randomised trials of smoking cessation interventions was conducted. Electronic searches were carried out on the following databases: MEDLINE, EMBASE, CINAHL and PsycINFO to September 2013. Searches were supplemented by review of trial registries and references from identified trials. Citations and full-text articles were screened by two reviewers. A random-effect Mantel-Haenszel model was used to pool data.
SETTING: Primary, secondary and tertiary care.
PARTICIPANTS: Adults with type 1 or type 2 diabetes.
INTERVENTIONS: Smoking cessation interventions or medication (more intensive interventions) compared to usual care, counselling or optional medication (less intensive interventions).
OUTCOME MEASURES: Biochemically verified smoking cessation was the primary outcome. Secondary outcomes were adverse events and effects on glycaemic control. We also carried out a pooled analysis of self-reported smoking cessation outcomes.
RESULTS: We screened 1783 citations and reviewed seven articles reporting eight trials in 872 participants. All trials were of 6 months duration. Three trials included pharmacotherapy for smoking cessation. The risk ratio of biochemically verified smoking cessation was 1.32 (95% CI 0.23 to 7.43) for the more intensive interventions compared to less intensive interventions with significant heterogeneity (I(2)=76%). Only one trial reported measures of glycaemic control.
CONCLUSIONS: There is an absence of evidence of efficacy for more intensive smoking cessation interventions in people with diabetes. The more intensive strategies tested in trials to date include interventions used in the general population, adding in diabetes-specific education about increased risk. Future research should focus on multicomponent smoking cessation interventions carried out over a period of at least 1 year, and also assess impact on glycaemic control.
 

BMJ Open. 2014 Mar 6;4(3):e004107. doi: 10.1136/bmjopen-2013-004107.