Impact of ENHANCED (diEtitiaNs Helping pAtieNts CarE for Diabetes) Telemedicine Randomized Controlled Trial on Diabetes Optimal Care Outcomes in Patients with Type 2 Diabetes
Impact of ENHANCED (diEtitiaNs Helping pAtieNts CarE for Diabetes) Telemedicine Randomized Controlled Trial on Diabetes Optimal Care Outcomes in Patients with Type 2 Diabetes
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DOI：
10.1016/j.jand.2018.11.013
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发表时间：
2019-04-01
影响因子：
4.8
通讯作者：
VanWormer, Jeff J.
中科院分区：
文献类型：
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作者：
Benson, Gretchen A.;Sidebottom, Abbey;VanWormer, Jeff J.
背景 2 型糖尿病的临床护理有所改善，但仍不理想。最大化不同学科技能的协作、基于团队的模型可能会改善对糖尿病患者的护理，但很少有经过严格研究设计的测试。目的 调查注册营养师主导的远程医疗计划与对照组在糖尿病最佳护理目标方面的效果。设计一项随机对照试验，其中参与者被分配到对照组或干预组。参与者/设置 118 名患有 2 型糖尿病的成年人（平均年龄，60 岁；45% 女性）参与这项研究于 2016 年 4 月至 2017 年 12 月期间进行。参与者是从明尼苏达州两个农村社区的独立初级保健诊所招募的。 干预 对于那些被分配进行干预的人，注册营养师除了提供医学营养治疗外，还使用治疗方案来启动和滴定血糖、高血压和血脂水平的治疗；远程医疗就诊补充了常规护理。 主要结果指标 主要结果包括复合型和个体糖尿病最佳护理目标：糖化血红蛋白、血压、不吸烟以及服用他汀类药物和阿司匹林（酌情）。次要指标包括体力活动、早餐、水果和蔬菜、全谷物、体重指数、低密度脂蛋白和药物依从性。统计分析使用混合模型回归来检查基线和 1 年随访之间的结果。结果发现，干预组在随访时达到的糖尿病最佳护理措施数量有适度但显着的改善（对照组为 3.7 比 3.2 [P=0.017]）。在个体测量中，干预组的药物使用量显着增加，服用他汀类药物 [95% CI，1.0 至 6.24]）和阿司匹林 [95% CI，0.90 至 5.19] 的几率分别高出 2.5 和 2.2（与对照组相比）。 ENHANCED 结论（营养师帮助患者护理糖尿病）研究结果表明，遵循药物治疗方案的注册营养师营养师可以有效改善对成人 2 型糖尿病患者的护理，并且可以作为医疗保健团队的一部分在提供循证、以患者为中心的护理方面发挥重要作用。
Background Clinical care for type 2 diabetes has improved but remains suboptimal. Collaborative, team-based models that maximize skills of different disciplines may improve care for individuals with diabetes, but few have been tested using rigorous research designs.Objective To investigate the efficacy of a registered dietitian nutritionist-led telemedicine program compared with that of a control group in terms of diabetes optimal care goals.Design A randomized controlled trial in which participants were assigned to a control or intervention group.Participants/setting One hundred eighteen adults with type 2 diabetes (mean age, 60 years; 45% female) participated in the study between April 2016 and December 2017. Participants were recruited from separate primary care clinics in two rural Minnesota communities.Intervention For those assigned to the intervention, registered dietitian nutritionists used a treatment protocol to initiate and titrate therapies for blood glucose, hypertension, and lipid levels in addition to providing medical nutrition therapy; telemedicine visits supplemented usual care.Main outcome measures Primary outcomes included composite and individual diabetes optimal care goals: hemoglobin A1c, blood pressure, not using tobacco, and taking a statin and aspirin (as appropriate). Secondary measures included physical activity, breakfast, fruits and vegetables, whole grains, body mass index, low-density lipoprotein, and medication adherence.Statistical analysis Mixed-model regression was used to examine outcomes between baseline and 1-year follow-up.Results A modest but significantly greater improvement in the number of diabetes optimal care measures met at follow-up was found in the intervention group (3.7 vs 3.2 in the control group [P=0.017]). Among individual measures, the intervention group had significantly greater medication use, with 2.5 and 2.2 higher odds (compared with the control group) of taking a statin [95% CI,1.0 to 6.24]) and aspirin [95% CI, 0.90 to 5.19] as appropriate, respectively.Conclusions ENHANCED (diEtitiaNs Helping pAtieNts CarE for Diabetes) findings suggest that registered dietitian nutritionists following medication treatment protocols can effectively improve care for adults with type 2 diabetes and can serve an instrumental role as part of the health care team in providing evidence-based, patient-centered care.