摘要
目的:探讨实时互动式远程糖尿病管理系统,应用于门诊2型糖尿病起始胰岛素治疗患者的效果。方法:入选口服药物控制不佳,需要起始胰岛素治疗的2型糖尿病门诊就诊患者60例,随机分配至远程管理组和常规门诊组,每组30例。2组均接受糖尿病专科护士胰岛素注射培训。远程组患者配备家用机及血糖仪等外围设备,实现家中检测数据的上传、各项检测实施的提醒、相关教育信息的转达、以及实现与远程管理者多功能互动。糖尿病专科护士在后台操作平台通过网络实时监控远程患者的检测指标,及时进行重点指标的干预管理。常规门诊组自行在家中监测血糖。2组均根据需要门诊随诊,研究进行3个月。比较2组在干预后糖代谢指标和自我管理技能的变化。结果:2组年龄、糖尿病病程、各项糖代谢指标以及自我管理行为量表得分在基线时,差异均无统计学(P>0.05)。在3个月后2组的空腹血糖、餐后2h血糖及HbA1c,均较基线时明显下降(P<0.001);并且远程组比常规组下降更为明显(P<0.001或P<0.05)。远程组HbA1c<7%达标率高于常规组(P<0.05)。远程组低血糖事件例次数明显少于常规组(32次vs.58次,P<0.01)。3个月后再次测评自我管理行为量表,2组6个分量表得分均较基线时明显提高(P<0.001或P<0.01);除用药管理行为外,其余5个量表远程组比常规组提高更为明显(P<0.001或P<0.05)。结论:短期实时互动式远程糖尿病管理模式较常规门诊管理可显著改善起始胰岛素治疗2型糖尿病患者糖代谢达标率,并提高患者自我管理技能水平。
Objective：To investigate the effectiveness of real-time interactive telecare system on optimizing the insulin treatment of type 2 diabetic out-patients.Methods：60 subjects with type-2 diabetes initiating insulin treatment were randomly allocated into the telecare group or the usual care group,consisting of 30 patients each.The usual care group was treated in the out-patient clinic based on the clinical examinations.The telecare system consists of the patient＇s teletransmission module and the central clinical control system.Each patient in the telecare group was equipped with a teletransmission module.The diabetes specialist nurse（DSN） sent individualized diabetes management to the patients of telecare group.According to the requirement,the patients uploaded home meter data and other pertinent data such as glucose,dietary diary,activity level,and medical history through home teletransmission module.Then DNS analyzed this data and provided feedback regarding lifestyle modification guidelines,and sent recommendations to them.Results：During the 3-month follow-up,both groups resulted in a reduction in fasting glucose,post-prandial glucose and HbA1c（P0.001） compared with baseline data.Additionally,as compared with usual care patients,telecare patients showed better glycemic control（P0.001 or P0.05） and success rate of HbA1c 7%（P0.05）,as well as a significant lower number of hypoglycemia episodes（P0.01）.Furthermore,the telecare group was observed with significantly higher scores with summary of diabetes self-care activities for type 2 diabetes patients（P0.001 or P0.05） three months later.Conclusion：Our data suggest that short periods of real-time and interactive home telecare system is very efficient and beneficial in terms of insulin treatment outcomes and patients＇ self management skills improvement for type 2 diabetic out-patients.
出处
《心肺血管病杂志》
CAS
2011年第4期306-310,共5页
Journal of Cardiovascular and Pulmonary Diseases
