老年糖尿病患者用药偏差危险因素的Meta分析

Risk Factors for Medication Deviation in Elderly Patients with Diabetes: A Meta-Analysis

摘要: 目的：通过Meta分析确定老年糖尿病患者用药偏差的危险因素。方法：计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Web of Science、Cochrane Library、Embase、CINAHL，检索时限为建库至2025年2月，由2名研究者独立进行文献筛选、质量评价和数据提取，采用RevMan 5.4软件进行Meta分析。结果：共纳入23篇文献(中文文献8篇，英文文献15篇)，包含39项相关危险因素，Meta分析结果显示：服药种类[OR = 1.55, 95%CI (1.13, 2.12), P = 0.006]、服药依从性[OR = 2.33, 95%CI (1.70, 3.31), P < 0.00001]、服药自我效能[OR = 0.57, 95%CI (0.48, 0.69), P < 0.00001]、对疾病的认识程度[OR = 2.64, 95%CI (1.84, 3.79), P < 0.00001]、服药频率[OR = 0.77, 95%CI (0.65, 0.91), P = 0.003]、糖尿病自我管理[OR = 0.95, 95%CI (0.92, 0.98), P = 0.001]、痴呆[OR = 0.81, 95%CI (0.74, 0.89), P < 0.0001]、抑郁[OR = 0.91, 95%CI (0.84, 0.99), P = 0.02]、年龄[OR = 0.97, 95%CI (0.96, 0.98)，P < 0.00001]、性别[OR = 1.61, 95%CI (1.27, 2.03), P < 0.0001]、经济水平[OR = 1.72, 95%CI (1.36, 2.19), P < 0.00001]、生活质量[OR = 3.75, 95%CI (1.88, 7.48), P = 0.0002]、共病[OR = 1.36, 95%CI (1.13, 1.64), P = 0.001]为老年糖尿病患者用药偏差的危险因素(P < 0.05)，此外药物储存条件、视力、药物不良反应、对药物的认识、定期复查、焦虑、健康素养、用药信念、体能活动、饮酒、医疗保险类型、社会支持、医患关系纳入文献数量 < 2篇，仅进行描述性分析。结论：老年患者糖尿病患者用药偏差的危险因素较多，护理人员应动态评估糖尿病患者的用药偏差情况，结合多学科协作模式，给予个体化、精准化的干预措施，改善或减少用药偏差。

Abstract: Objective: To determine the risk factors of medication deviation in elderly patients with diabetes through meta-analysis. Methods: Computer searches were conducted on CNKI, Wanfang, VIP, China Biomedical Literature Database, PubMed, Web of Science, Cochrane Library, Embase and CINAHL from the establishment of the database to February 2025. Literature screening, quality evaluation and data extraction were conducted independently by two researchers, and meta-analysis was performed using RevMan 5.4 software. Results: A total of 23 literatures (8 Chinese literatures and 15 English literatures) were included, including 39 related risk factors. The results of meta-analysis showed: Medication type [OR = 1.55, 95%CI (1.13, 2.12), P = 0.006], medication compliance [OR = 2.33, 95%CI (1.70, 3.31), P < 0.00001], medication self-efficacy [OR = 0.57, 95%CI (0.48, 0.69), P < 0.00001], degree of awareness of the disease [OR = 2.64, 95%CI (1.84,3.79), P < 0.00001], frequency of medication [OR = 0.77, 95%CI (0.65, 0.91), P = 0.003], diabetes self-management [OR = 0.95, 95%CI (0.92, 0.98), P = 0.001], dementia [OR = 0.81, 95%CI (0.74, 0.89), P < 0.0001], depression [OR = 0.91, 95%CI (0.84, 0.99), P = 0.02], age [OR = 0.97, 95%CI (0.96, 0.98), P < 0.00001], gender [OR = 1.61, 95%CI (1.27, 2.03), P < 0.0001], economic level [OR = 1.72, 95%CI (1.36,2.19), P < 0.00001], quality of life [OR = 3.75, 95%CI (1.88, 7.48), P = 0.0002], comorbidity [OR = 1.36, 95%CI (1.13, 1.64), P = 0.001] was the risk factor for medication bias in elderly diabetic patients (P < 0.05). In addition, drug storage conditions, vision, adverse drug reactions, drug awareness, regular review, anxiety, health literacy, drug belief, physical activity, alcohol consumption, type of medical insurance, social support and doctor-patient relationship were included in less than 2 literatures. Descriptive analysis only. Conclusions: There are many risk factors for medication bias in elderly patients with diabetes. Nursing staff should dynamically evaluate the medication bias in diabetic patients, and combine the multi-disciplinary collaboration model to give individualized and precise intervention measures to improve or reduce medication bias.