Improved Medication Adherence and Frequency of Blood Glucose Self-Testing Using an m-Health Platform Versus Usual Care in a Multisite Randomized Clinical Trial Among People with Type 2 Diabetes in India
Improved Medication Adherence and Frequency of Blood Glucose Self-Testing Using an m-Health Platform Versus Usual Care in a Multisite Randomized Clinical Trial Among People with Type 2 Diabetes in India
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DOI：
10.1089/tmj.2016.0265
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发表时间：
2017-09-01
影响因子：
4.7
通讯作者：
Viswanathan, Vijay
中科院分区：
文献类型：
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作者：
Kleinman, Nora J.;Shah, Avani;Viswanathan, Vijay
背景：2015 年，印度估计有 6920 万人患有糖尿病，全国患病率为 8.7%。越来越多的证据表明远程医疗在糖尿病护理中的益处，但移动医疗（移动健康）干预措施仍然有限。简介：本研究评估了移动健康糖尿病平台对临床结果、患者报告结果、患者和提供者满意度以及应用程序使用的影响。 材料和方法：这项开放标签、双臂平行研究在印度 3 个地点招募了 91 名受试者，他们年龄在 18-65 岁之间，患有 2 型糖尿病，A1c 在 7.5% 到 12.5% 之间 (58113 mmol/mol)。参与者按 1:1 的比例随机分配至 m-Health 或常规护理组，并观察 6 个月。所有人都获得了免费探访、实验室检测、交通费以及试纸和刺血针。干预参与者收到了移动健康应用程序和手机数据津贴。结果：之前报告称 A1c 变化具有统计显着性。从基线开始 6 个月，干预组参与者的药物依从性得到改善（39.0% 对比 12.8%；p = 0.03），血糖 (BG) 自检频率显着增加（39.0% 对比 10.3%；p = 0.01）。其他结果没有显着差异。在移动健康用户中，75% 的参与者在第 24 周积极使用该应用程序。参与者输入了 29,668 种药物和 2,575 条血糖读数，发送了 497 条消息，并收到了 890 条消息。大多数参与者 (80%) 对应用程序的各个方面都感到满意，所有七家提供商都认为该软件非常可接受。讨论：与常规护理参与者相比，分配到移动健康的参与者增加了药物依从性和 BG 测试频率。结论：该工具可能是扩大获得优质慢性病护理和改善结果的有效方法。
Background: In 2015, India had an estimated 69.2 million people with diabetes and a national prevalence of 8.7%. Evidence is mounting for the benefits of telemedicine in diabetes care, but remains limited on mobile-health (m-Health) interventions. Introduction: This study assessed the impact of an m-Health diabetes platform on clinical outcomes, patient-reported outcomes, patient and provider satisfaction, and app usage.Materials and Methods: This open-label, two-arm parallel study enrolled 91 people at 3 sites in India, aged 18-65, with type 2 diabetes, and an A1c between 7.5% and 12.5% (58113 mmol/mol). Participants were randomly assigned 1: 1 to m-Health or usual care and observed for 6 months. All received free visits, laboratory tests, transportation fees, and strips and lancets. Intervention participants received the m-Health app and a mobile phone data stipend.Results: A1c change was previously reported as statistically significant. Significantly more participants in intervention than control had improved medication adherence (39.0% vs. 12.8%; p = 0.03) and increased frequency of blood glucose (BG) self-testing (39.0% vs. 10.3%; p = 0.01) at 6 months from baseline. No other outcomes were significantly different. Among m-Health users, 75% of participants actively used the app at week 24. Participants entered 29,668 medications and 2,575 BG readings, sent 497 messages, and received 890 messages. Most participants (80%) were satisfied with all aspects of the app and all seven providers rated the software very acceptable.Discussion: Participants assigned to m-Health had increased medication adherence and frequency of BG testing compared with usual care participants.Conclusions: This tool could be an effective way to expand access to quality chronic disease care and improve outcomes.