Tele Health Improves Diabetes Self-Management in an Underserved Community Diabetes TeleCare
Tele Health Improves Diabetes Self-Management in an Underserved Community Diabetes TeleCare
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DOI：
10.2337/dc09-1919
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发表时间：
2010-08-01
期刊：
影响因子：
16.2
通讯作者：
Mayer-Davis, Elizabeth J.
中科院分区：
文献类型：
--
作者：
Davis, Richard M.;Hitch, Angela D.;Mayer-Davis, Elizabeth J.
目的：开展一项为期1年的随机临床试验，以评估由营养师和护士/注册糖尿病教育者（CDE）在南卡罗来纳州农村联邦合格健康中心（FQHC）实施的远程综合糖尿病自我管理教育（DSME）干预。研究设计和方法从FQHC的三个成员健康中心招募参与者，并随机分配到糖尿病远程医疗，使用远程医疗策略提供12个月，13次课程，或常规护理。结果：重复测量的混合线性回归模型结果显示，与常规治疗（分别为8.8 +/- 0.3、8.6 +/- 0.3和8.6 +/- 0.3）相比，Diabetes TeleCare组从基线到6个月和12个月的糖化血红蛋白（GHb）显著降低（分别为9.4 +/- 0.3、8.3 +/- 0.3和8.2 +/- 0.4）。与常规护理相比，糖尿病远程护理组在12个月时降低了LDL胆固醇。虽然不是原始研究设计的一部分，但在完成24个月随访的随机样本的一个亚组的事后分析中，与常规治疗（分别为8.7 +/- 0.4,8.1 +/- 0.4和8.1 +/- 0.5）相比，Diabetes TeleCare组的GHb从基线降低到12和24个月（分别为9.2 +/- 0.4,7.4 +/- 0.5和7.6 +/- 0.5）。结论：远程医疗有效地为一名护士、CDE和营养师成功进行为期1年的远程DSME创造了机会，改善了不同种族和农村人群的代谢控制，降低了心血管风险。
OBJECTIVE To conduct a 1-year randomized clinical trial to evaluate a remote comprehensive diabetes self-management education (DSME) intervention, Diabetes TeleCare, administered by a dietitian and nurse/certified diabetes educator (CDE) in the setting of a federally qualified health center (FQHC) in rural South Carolina.RESEARCH DESIGN AND METHODS Participants were recruited from three member health centers of an FQHC and were randomized to either Diabetes TeleCare, a 12-month, 13-session curriculum delivered using telehealth strategies, or usual care.RESULTS Mixed linear regression model results for repeated measures showed a significant reduction in glycated hemoglobin (GHb) in the Diabetes TeleCare group from baseline to 6 and 12 months (9.4 +/- 0.3, 8.3 +/- 0.3, and 8.2 +/- 0.4, respectively) compared with usual care (8.8 +/- 0.3, 8.6 +/- 0.3, and 8.6 +/- 0.3, respectively). LDL cholesterol was reduced at 12 months in the Diabetes TeleCare group compared with usual care. Although not part of the original study design, GHb was reduced from baseline to 12 and 24 months in the Diabetes TeleCare group (9.2 +/- 0.4, 7.4 +/- 0.5, and 7.6 +/- 0.5, respectively) compared with usual care (8.7 +/- 0.4, 8.1 +/- 0.4, and 8.1 +/- 0.5, respectively) in a post hoc analysis of a subset of the randomized sample who completed a 24-month follow-up visit.CONCLUSIONS Telehealth effectively created access to successfully conduct a 1-year remote DSME by a nurse CDE and dietitian that improved metabolic control and reduced cardiovascular risk in an ethnically diverse and rural population.