步行運動對糖尿病控制改善成效：統合分析

背景：運動可以改善第二型糖尿病病人葡萄糖利用，步行是最簡單及方便的運動，然而，步行運動對於血糖控制的成效仍缺乏一致結果。目的：以統合分析探討行步行運動對於第二型糖尿病病人的糖化血色素、空腹血糖及身體質量指數改的善效果。方法：搜尋CINAHL、Cochrane Library、MEDLINE、PubMed、Wed of science及華藝線上圖書館（CEPS）等六個資料庫2018年12月前的隨機對照性試驗，由兩位作者以Cochrane Risk of Bias Tool評估文章品質，使用Review Manager 5.3進行資料處理及分析。結果：共獲得293篇文獻、篩選後納入9篇研究，證據品質為低誤差風險的中至高等級，結果為步行運動可以顯著降低糖化血色素（p < .001, WMD -0.41, 95% CI: -0.61 to -0.22）、空腹血糖（p < .001, WMD -12.43, 95% CI: -17.25 to -7.61）但無法降低身體質量指數（p= .07）。實務應用：應鼓勵第二型糖尿病人每週至少3次，每次以每分鐘120步的速度連續步行30分鐘以上（約4,000步），並持續8週以上，做為控制糖化血色素及空腹血糖簡易的方法。

關鍵字

第二型糖尿病；步行運動；糖化血色素；空腹血糖；身體質量指數

並列摘要

Background: Walking improves glucose metabolism and is the easiest exercise for diabetes patients. However, there is a lack of consistent research findings on the effects of walking on the control of type 2 diabetes patients. Purpose: To evaluate the association between walking and hemoglobin A1c (HbA1c), fasting blood sugar (FBS), and body mass index (BMI) in type 2 diabetes patients. Methods: Literature review using the databases of CINAHL, Cochrane Library, PubMed, MEDLINE, Wed of science, CEPS, and the randomized clinical trials (RCTs) up to December 2018. The evaluation of methodological quality used Cochrane Risk of Bias Tool by two reviewers and data were analyzed using Review Manager 5.3. Results: Nine studies met the review criteria. Evidence qualities were from moderate to high with low risk of bias. The data showed that walking significantly decreased glycosylated hemoglobin A1c (HbA1c) by 0.41% (p < .001, WMD -0.41, 95% CI: -0.61 to -0.22), and fasting blood sugar (FBS) (p < .001, WMD -12.43, 95% CI: -17.25 to -7.61). The body mass index (BMI) changes were not significant (p = .07). Implications for practice: Based on meta-analysis results, type 2 diabetes patients should be encouraged to take moderate -intensity walking at least 3 times a week for 30 minutes each time at a speed of 120 steps per minute (about 4,000 steps) and continue for at least 8 weeks, as a simple method to control HbA1c and FBS.

並列關鍵字

type 2 diabetes ； walking ； glycosylated hemoglobin A1c (HbA1c) ； fasting blood sugar (FBS) ； body mass index (BMI)

參考文獻

李書芬 (2018)．比較結構式有氧運動與萬步運動對胰島β細胞功能、代謝指標及身體組成之影響：以第二型糖尿病病患為例。體育學報，51 (3), 293-305。https://doi.org/10.3966/102472972018095103002

莊其穆 (2011)．臨床醫師如何閱讀統合分析（Meta-analysis）的論文，台灣醫界，54(2). 18-26 https://doi.org/10.30044/TMJ.201102.0003

黃萱、林毅欣 (2018)．高齡（65歲以上）第2型糖尿病患者之處置：文獻回顧。內科學誌，29 (6), 374-380。https://doi.org/10.6314/JIMT.201812_29(6).04

American Diabetes Association (2020). Standards of medical care in Diabetes-2020 abridged for primary care providers. Clinical Diabetes, 38(1). 10-38. https://doi.org/10.2337/cd20-as01

Delevatti, R. S., Bracht, C. G., Lisboa, S. D. C., Costa, R. R., Marson, E. C., Netto, N., & Kruel, L. F. M. (2019). The role of aerobic training variables progression on glycemic control of patients with type 2 diabetes: A Systematic review with meta-analysis. Sports Medicine-Open, 5(1), 22. https://doi.org/10.1186/s40798-019-0194-z

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