糖尿病远程管理系统的应用及对代谢指标的改善作用

A Randomized Controlled Trial of a Multidisciplinary Telemedicine Intervention for Patients with Type-2 diabetes

目的探讨糖尿病远程网络管理对糖尿病患者代谢指标的改善作用。方法将120例2型糖尿病患者随机分为网络管理组和常规门诊组,每组60例。两组均接受每周一次的糖尿病自我管理技能培训。网络管理组患者配备家用电脑,由疾病管理师通过Lifelink糖尿病远程管理系统进行糖尿病日常网络管理,制定个性化管理目标,实现家中检测数据的上传、各项检测实施的提醒、相关教育信息的转达以及实现与远程管理人员多功能互动。管理实施3个月后,比较管理前后糖、脂代谢等指标的变化。结果两组年龄、糖尿病病程差异均无统计学意义,各项生化指标在基线时除尿酸外差异均无统计学意义。经过3个月的管理,网络管理组和常规门诊组的体重、腰围、体质指数(BMI)、尿酸及血脂成分(总胆固醇、三酰甘油、低密度脂蛋白胆固醇)均较基线时明显下降(P<0.05或P<0.01);两组间比较差异无统计学意义。两组糖化血红蛋白在3个月后亦均较基线时下降,并且网络组比常规组下降更为明显(P<0.05)。两组的空腹血糖和尿白蛋白/尿肌酐均无明显变化。网络管理组低血糖事件(15.3%)较常规门诊组(31.0%)明显减少(P<0.05),并且网络管理组血糖变异系数低于常规门诊组(P<0.01)。结论短期远程网络管理模式较常规管理可显著改善2型糖尿病糖代谢指标。

Objective To investigate the effectiveness of telemedicine intervention on metabolic factors improvement in patients with diabetes. Methods 120 subjects with type-2 diabetes were enrolled in this 3-month study. They were randomly divided into the web-based group and usual care group, and all of them received diabetes serf-management education once a week. For web-based patients, they uploaded home meter data and other pertinent data such as anti-hyperglcemic regimens, dietary diary, activity level, and medical history through home computer. Then disease care managers reviewed this data and provided feedback regarding lifestyle modification guidelines, and sent recommendations for individualized diabetes management to the patients. Results During the 3-month follow-up, both groups resulted in a reduction in weight, waist circumference, BMI, and lipid parameters （P〈0.05 or P〈0.01） compared with baseline data, whereas no significant differences were between the two groups （P〉0.05）. A significant reduction of HbA1c was observed in both groups, and web-based patients showed better improvement compared with usual care patients （P〈0.05）. Furthermore, as compared with usual care patients, web-based patients were observed with significantly lower hypoglycemic events （P〈0.05）, as well as lower glucose coefficients of variation （P〈0.01）. Conclusion Our data suggests that short- term telemedicine intervention for type 2 diabetes management could improve glucose control better than usual care.