卫生系统障碍及加强中低收入国家儿童1型糖尿病早期发现的路径：一项系统综述。
完整摘要 · 中文译文
背景：1型糖尿病（T1DM）影响全球约120万儿童和青少年。在低收入和中等收入国家（LMICs），诊断延迟是导致高发病率和死亡率的关键因素。现有证据提示诊断路径中存在系统性障碍。本系统综述旨在综合关于LMICs中儿童T1DM早期检测促进因素和障碍的证据。 方法：我们按照系统综述和荟萃分析优先报告条目（PRISMA）指南进行了系统综述。于2026年2月和3月检索了PubMed、Web of Science、Embase和Cochrane Library。另行对世界卫生组织IRIS知识库和国际糖尿病联盟网站进行了针对性的灰色文献检索。若研究考察了改善LMICs中儿童T1DM及时检测和诊断的干预措施、实施策略或卫生系统方法，则符合纳入标准。两名综述作者在Covidence中独立筛选研究。评估了偏倚风险，并依据世界卫生组织卫生系统构建模块框架，采用描述性和主题分析对研究结果进行了综合。 结果：九项研究符合纳入标准。障碍最常出现在服务提供、卫生人力资源和诊断可及性方面。早期检测在很大程度上是被动的，且集中在较高级别机构，与初级保健的整合有限。转诊路径碎片化、与照护的衔接薄弱以及提供者知识方面的差距 边缘因素导致了诊断延迟。包括与现有项目整合以及基于社区的策略在内的多种方法显示出前景；然而，这些方法并未得到大规模实施，且仍呈碎片化状态。 结论：中低收入国家儿童1型糖尿病的早期发现仍面临挑战，其主要制约因素在于卫生系统限制，而非缺乏诊断工具。评估已实施策略的证据仍然有限。解决这些延迟需要协调一致的系统级策略，以加强初级保健能力、扩大首次就诊点的基本血糖检测可及性，并改善整个诊疗路径中的转诊和随访。评估已实施干预措施的研究数量有限，凸显了在资源受限环境中开展可扩展、整合式方法研究的迫切需求。 试验注册：CRD420261330542（2026年3月3日）。
完整摘要 · 英文原文
BACKGROUND: Type 1 diabetes mellitus (T1DM) affects approximately 1.2 million children and adolescents globally. Delayed diagnosis in low- and middle-income countries (LMICs) is a key factor for high morbidity and mortality. The available evidence suggests systemic barriers across the diagnostic pathway. This systematic review aims to synthesize evidence on facilitators and barriers to early detection of pediatric T1DM in LMICs. METHODS: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Web of Science, Embase and Cochrane Library were searched in February and March 2026. Additional targeted grey literature searches of the World Health Organization IRIS repository, and the International Diabetes Federation website were conducted separately. Studies were eligible if they examined interventions, implementation strategies, or health system approaches to improve timely detection and diagnosis of pediatric T1DM in LMICs. Two reviewers independently screened studies in Covidence. Risk of bias was assessed, and findings were synthesized using descriptive and thematic analysis according to the WHO health system building blocks framework. RESULTS: Nine studies met the inclusion criteria. Barriers were most frequently identified in service delivery, the health workforce, and access to diagnostics. Early detection was largely passive and concentrated in higher-level facilities, with limited integration into primary care. Fragmented referral pathways, weak linkage to care, and gaps in provider knowledge contributed to delayed diagnosis. Several approaches, including integration with existing programs and community-based strategies, demonstrated promise; however, they were not implemented at scale and remained fragmented. CONCLUSION: Early detection of pediatric T1DM in LMICs remains challenging and is primarily constrained by health system limitations rather than the absence of diagnostic tools. Evidence evaluating implemented strategies remains limited. Addressing these delays requires coordinated, system-level strategies that strengthen primary care capacity, expand access to basic blood glucose testing at first-contact points, and improve referral and follow-up across the care pathway. The limited number of studies evaluating implemented interventions highlights a critical need for research on scalable, integrated approaches in resource-constrained settings. TRIAL REGISTRATION: CRD420261330542 (March 03, 2026).