Outcomes of DSME programs/interventions.

Diabetes mellitus is a chronic metabolic health condition affecting millions globally. Diabetes is a growing concern among aging societies, with its prevalence increasing among those aged 65 and above. Enabling disease self-management via relevant education is part of high-quality care to improve health outcomes and minimize complications for individuals living with diabetes. Successful diabetes self-management education (DSME) programs usually require tailoring for the intended audience; however, there is limited literature about the preferences of older persons in Western countries concerning DSME. As such, a broad overview of DSME for older persons was an identified need. To map the available evidence on DSME for persons aged 65 years and older in Western countries, the JBI methodology for conducting and reporting scoping reviews was used. In this scoping review, we considered all studies about DSME for older persons with T1D and T2D in Western countries where lifestyles, risks, prevention, treatment of diabetes, and approaches to self-management and DSME are similar (e.g., North America, Western and Northern Europe and Australasia). Systematic keyword and subject heading searches were conducted in 10 databases (e.g., MEDLINE, JBI EBP) to identify relevant English language papers published from 2000 to 2022. Titles and abstracts were screened to select eligible papers for full-text reading. Full-text screening was done by four independent reviewers to select studies for the final analysis. The review identified 2,397 studies, of which 1,250 full texts were screened for eligibility. Of the final 44 papers included in the review, only one included participants’ understanding of DSME. The education programs differed in their context, design, delivery mode, theoretical underpinnings, and duration. Type of research designs, outcome measures used to determine the effectiveness of DSME, and knowledge gaps were also detailed. Overall, most interventions were effective and improved clinical and behavioural outcomes. Many of the programs led to improvements in clinical outcomes and participants’ quality of life; however, the content needs to be adapted to older persons according to their culture, different degrees of health literacy, preference of education (e.g., individualized or group), preference of setting, degree of frailty and independence, and comorbidities. Few studies included the voices of older persons in the design, implementation, and evaluation of DSME programs. Such experiential knowledge is vital in developing educational programs to ensure alignment with this population’s preferred learning styles, literacy levels, culture, and needs—such an approach could manifest more substantive, sustained results.糖尿病（Diabetes mellitus）是一种在全球范围内影响数百万人的慢性代谢性疾病。在老龄化社会中，糖尿病已成为日益严峻的公共卫生关切，65岁及以上人群的患病率持续上升。通过相关教育支持患者开展疾病自我管理，是优质医疗照护的核心内容之一，旨在改善糖尿病患者的健康结局并降低并发症发生风险。 成功的糖尿病自我管理教育（Diabetes Self-Management Education, DSME）项目通常需要针对目标受众进行定制化设计，但目前针对西方国家老年人群DSME偏好的相关研究文献较为匮乏。因此，学界明确提出需对老年人群DSME开展全面梳理。本研究采用JBI范围综述方法学（JBI methodology），对西方国家65岁及以上老年糖尿病患者的DSME现有证据进行图谱分析。 本次范围综述纳入所有针对西方国家1型糖尿病（Type 1 Diabetes, T1D）与2型糖尿病（Type 2 Diabetes, T2D）老年患者的DSME相关研究，上述地区在糖尿病的生活方式、危险因素、预防与治疗手段、自我管理及DSME路径等方面具有相似性（包括北美、西欧、北欧及澳大拉西亚地区）。 研究团队通过系统的关键词与主题词检索策略，在10个数据库（如医学文献分析与检索系统MEDLINE、JBI循证实践数据库JBI EBP）中检索2000年至2022年间发表的英文相关文献。首先对文献标题与摘要进行筛选，以遴选符合纳入标准的文献进行全文阅读；随后由4名独立评审员开展全文筛查，最终确定纳入最终分析的研究。 本综述共检索到2397项研究，其中1250篇全文文献接受了纳入资格筛查。最终纳入综述的44篇文献中，仅1项研究涉及参与者对DSME的认知情况。 现有教育项目在实施场景、设计方案、交付模式、理论基础及周期等方面均存在差异。研究同时详细记录了所采用的研究设计类型、用于评估DSME有效性的结局指标，以及当前研究存在的知识缺口。 整体而言，多数干预措施可有效改善临床与行为结局，多项项目亦能提升患者的临床结局与生活质量。但现有教育内容需根据老年人群的文化背景、健康素养水平、教育偏好（如个体化或团体教学）、学习场景偏好、衰弱程度与独立能力，以及共病情况进行针对性调整。 目前仅有极少数研究在DSME项目的设计、实施与评估阶段纳入老年人群的真实诉求。这类经验性知识对于开发贴合目标人群偏好学习方式、健康素养水平、文化背景与实际需求的教育项目至关重要，此类举措有望实现更具实质性与可持续性的干预效果。