Quinn Charlene C, Clough Suzanne Sysko, Minor James M, Lender Dan, Okafor Maria C, Gruber-Baldini Ann
Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Diabetes Technol Ther. 2008 Jun;10(3):160-8. doi: 10.1089/dia.2008.0283.
Less than 63% of individuals with diabetes meet professional guidelines target of hemoglobin A1c <7.0%, and only 7% meet combined glycemic, lipid, and blood pressure goals. The primary study aim was to assess the impact on A1c of a cell phone-based diabetes management software system used with web-based data analytics and therapy optimization tools. Secondary aims examined health care provider (HCP) adherence to prescribing guidelines and assessed HCPs' adoption of the technology.
Thirty patients with type 2 diabetes were recruited from three community physician practices for a 3-month study and evenly randomized. The intervention group received cell phone-based software designed by endocrinologists and CDEs (WellDoc Communications, Inc., Baltimore, MD). The software provided real-time feedback on patients' blood glucose levels, displayed patients' medication regimens, incorporated hypo- and hyperglycemia treatment algorithms, and requested additional data needed to evaluate diabetes management. Patient data captured and transferred to secure servers were analyzed by proprietary statistical algorithms. The system sent computer-generated logbooks (with suggested treatment plans) to intervention patients' HCPs.
The average decrease in A1c for intervention patients was 2.03%, compared to 0.68% (P < 0.02, one-tailed) for control patients. Of the intervention patients, 84% had medications titrated or changed by their HCP compared to controls (23%, P = 0.002). Intervention patients' HCPs reported the system facilitated treatment decisions, provided organized data, and reduced logbook review time.
Adults with type 2 diabetes using WellDoc's software achieved statistically significant improvements in A1c. HCP and patient satisfaction with the system was clinically and statistically significant.
不到63%的糖尿病患者达到糖化血红蛋白A1c<7.0%的专业指南目标，只有7%的患者达到血糖、血脂和血压的综合目标。主要研究目的是评估基于手机的糖尿病管理软件系统与基于网络的数据分析和治疗优化工具结合使用对糖化血红蛋白A1c的影响。次要目的是检查医疗保健提供者（HCP）对处方指南的遵守情况，并评估HCP对该技术的采用情况。
从三个社区医生诊所招募了30名2型糖尿病患者进行为期3个月的研究，并将其平均随机分组。干预组使用内分泌学家和糖尿病教育者（CDE）设计的基于手机的软件（WellDoc Communications，Inc.，巴尔的摩，马里兰州）。该软件提供患者血糖水平的实时反馈，显示患者的用药方案，纳入低血糖和高血糖治疗算法，并要求提供评估糖尿病管理所需的其他数据。通过专有的统计算法分析捕获并传输到安全服务器的患者数据。该系统向干预患者的HCP发送计算机生成的日志（以及建议的治疗计划）。
干预患者的糖化血红蛋白A1c平均下降2.03%，而对照患者为0.68%（P<0.02，单尾）。在干预患者中，84%的患者其HCP对药物进行了滴定或更改，而对照组为23%（P=0.002）。干预患者的HCP报告该系统有助于治疗决策，提供有条理的数据，并减少了日志审查时间。
使用WellDoc软件的2型糖尿病成人患者在糖化血红蛋白A1c方面取得了具有统计学意义的显著改善。HCP和患者对该系统的满意度在临床和统计学上均具有显著意义。
