Glycemic Control and Health Disparities in Older Ethnically Diverse Underserved Adults With Diabetes Five-year results from the Informatics for Diabetes Education and Telemedicine (IDEATel) study
Glycemic Control and Health Disparities in Older Ethnically Diverse Underserved Adults With Diabetes Five-year results from the Informatics for Diabetes Education and Telemedicine (IDEATel) study
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DOI：
10.2337/dc10-1346
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发表时间：
2011-02-01
期刊：
影响因子：
16.2
通讯作者：
Shea, Steven
中科院分区：
文献类型：
--
作者：
Weinstock, Ruth S.;Teresi, Jeanne A.;Shea, Steven
糖尿病教育和远程医疗信息学（IDEATel）项目将不同种族的糖尿病患者随机分配到远程医疗干预或常规护理。干预参与者在5年内的A1C水平较低。研究设计和方法IDEATel随机医疗保险受益人糖尿病（n = 1，665）接受家庭视频访问与糖尿病教育和上传葡萄糖水平每4 - 6周或常规护理（2000 - 2007年）。年度测量包括BMI，A1C（主要结果）和完成问卷。采用随机效应进行混合模型分析，以调整初级保健医生中的聚类。非西班牙裔白人（n = 821）和非西班牙裔黑人（n = 248）的平均值（平均值+/-SD）分别为7.02 +/-1.25%和7.58 +/-1.78%，西班牙裔为7.79 ± 1.68%（n = 585）。随着时间的推移，较低的A1C水平与更多的葡萄糖上传（P = 0.02）和女性性别（P = 0.002）相关。黑人、西班牙裔和胰岛素使用者的A1C水平高于非西班牙裔白人（P <0.0001）。BMI与A1C水平无关。随着时间的推移，黑人和西班牙裔的上传量明显少于非西班牙裔白人。西班牙裔的基线A1C水平最高，并且在干预中表现出最大的改善，但是，与非西班牙裔白人不同，西班牙裔没有达到A1C水平
OBJECTIVE-The Informatics for Diabetes Education and Telemedicine (IDEATel) project randomized ethnically diverse underserved older adults with diabetes to a telemedicine intervention or usual care. Intervention participants had lower A1C levels over 5 years. New analyses were performed to help better understand this difference.RESEARCH DESIGN AND METHODS-IDEATel randomized Medicare beneficiaries with diabetes (n = 1,665) to receive home video visits with a diabetes educator and upload glucose levels every 4-6 weeks or usual care (2000-2007). Annual measurements included BMI, A1C (primary outcome), and completion of questionnaires. Mixed-model analyses were performed using random effects to adjust for clustering within primary care physicians.RESULTS-At baseline, A1C levels (mean +/- SD) were 7.02 +/- 1.25% in non-Hispanic whites (n = 821), 7.58 +/- 1.78% in non-Hispanic blacks (n = 248), and 7.79 +/- 1.68% in Hispanics (n = 585). Over time, lower A1C levels were associated with more glucose uploads (P = 0.02) and female sex (P = 0.002). Blacks, Hispanics, and insulin-users had higher A1C levels than non-Hispanic whites (P < 0.0001). BMI was not associated with A1C levels. Blacks and Hispanics had significantly fewer uploads than non-Hispanic whites over time. Hispanics had the highest baseline A1C levels and showed the greatest improvement in the intervention, but, unlike non-Hispanic whites, Hispanics did not achieve A1C levels