Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial.
Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial.
复制标题
DOI：
10.1186/1471-2458-14-71
复制
发表时间：
2014-01-23
影响因子：
4.5
通讯作者：
Ory MG
中科院分区：
文献类型：
--
作者：
Forjuoh SN;Bolin JN;Huber JC Jr;Vuong AM;Adepoju OE;Helduser JW;Begaye DS;Robertson A;Moudouni DM;Bonner TJ;McLeroy KR;Ory MG
糖尿病患者的自我护理已被证明有助于降低疾病严重程度和相关的医疗成本。我们比较了两种不同的糖尿病自我护理干预在不同种族/民族人群中控制血糖的有效性。我们还探索了糖化血红蛋白(HbA1c)的减少是否会在少数人中更加明显。我们对376例年龄18岁、糖化血红蛋白(≥)为≥7.5%(≥58)的2型糖尿病患者进行了一项开放标签随机对照试验。参与者被随机分为：1)慢性病自我管理计划(CDSMP；n=101)；2)个人数字助理上的糖尿病自我护理软件(PDA；n=81)；3)干预组合(CDSMP+PDA；n=99)；或4)常规护理(对照组；n=95)。招生于2009年1月至2011年6月在大学附属的多专业团体诊所的七个地区诊所进行。主要结果是HbA1c从随机化变为12个月。使用多水平统计模型对数据进行分析。CDSMP组、PDA组、CDSMP+PDA组和对照组的平均基线糖化血红蛋白分别为9.4%、9.3%、9.2%和9.2%。在12个月时，两组的HbA1c平均分别下降了1.1%、0.7%、1.1%和0.7%，与基于模型的基线没有显著差异(P=.771)。除了PDA组的参与者报告比他们的同行吃更多的高脂肪食物(P<；.004)外，在参与者的糖尿病自我护理活动中没有观察到其他显著的差异。探索性的分分析没有显示少数人的糖化血红蛋白有任何明显的下降，但所有种族/族裔群体的HbA1c都有适度的下降。虽然行为和技术干预可以在血糖控制方面产生一些适度的改善，但在实现血糖控制方面，这些干预措施的效果并没有明显好于常规护理。需要更多的研究来了解这些干预措施如何在临床实践中最有效。在接受常规护理的对照组中发现的HbA1c水平的降低也表明，在综合医疗系统中良好的常规护理可以导致更好的血糖控制。ClinicalTrials.gov标识：NCT01221090。
Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs. We compared the effectiveness of two different diabetes self-care interventions on glycemic control in a racially/ethnically diverse population. We also explored whether reductions in glycated hemoglobin (HbA1c) will be more marked in minority persons. We conducted an open-label randomized controlled trial of 376 patients with type 2 diabetes aged ≥18 years and whose last measured HbA1c was ≥7.5% (≥58 mmol/mol). Participants were randomized to: 1) a Chronic Disease Self-Management Program (CDSMP; n = 101); 2) a diabetes self-care software on a personal digital assistant (PDA; n = 81); 3) a combination of interventions (CDSMP + PDA; n = 99); or 4) usual care (control; n = 95). Enrollment occurred January 2009-June 2011 at seven regional clinics of a university-affiliated multi-specialty group practice. The primary outcome was change in HbA1c from randomization to 12 months. Data were analyzed using a multilevel statistical model. Average baseline HbA1c in the CDSMP, PDA, CDSMP + PDA, and control arms were 9.4%, 9.3%, 9.2%, and 9.2%, respectively. HbA1c reductions at 12 months for the groups averaged 1.1%, 0.7%, 1.1%, and 0.7%, respectively and did not differ significantly from baseline based on the model (P = .771). Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts (P < .004), no other significant differences were observed in participants’ diabetes self-care activities. Exploratory sub-analysis did not reveal any marked reductions in HbA1c for minority persons but rather modest reductions for all racial/ethnic groups. Although behavioral and technological interventions can result in some modest improvements in glycemic control, these interventions did not fare significantly better than usual care in achieving glycemic control. More research is needed to understand how these interventions can be most effective in clinical practice. The reduction in HbA1c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control. Clinicaltrials.gov Identifier: NCT01221090.
登录
查看更多内容
影响因子：
16.2
作者：
Adams, AS;Zhang, F;Ross-Degnan, D
通讯作者：
Ross-Degnan, D
影响因子：
3
作者：
Egede, Leonard E.;Mueller, Martina;Gebregziabher, Mulugeta
通讯作者：
Gebregziabher, Mulugeta
DOI：
10.3122/jabfm.2007.04.060166
发表时间：
2007-07-01
影响因子：
2.9
作者：
Forjuoh, Samuel N.;Reis, Michael D.;Molonket-Lanning, Susan
通讯作者：
Molonket-Lanning, Susan
DOI：
10.1089/tmj.2007.0053
发表时间：
2008-04-01
期刊：
TELEMEDICINE JOURNAL AND E-HEALTH
影响因子：
--
作者：
Forjuoh, Samuel N.;Reis, Michael D.;Ory, Marcia G.
通讯作者：
Ory, Marcia G.
DOI：
10.1111/j.1742-1241.2009.02277.x
发表时间：
2010-02-01
期刊：
International journal of clinical practice. Supplement
影响因子：
--
作者：
Kaufman, N
通讯作者：
Kaufman, N