Boaz Mona, Hellman Katerina, Wainstein Julio
Epidemiology and Research Unit, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Diabetes Technol Ther. 2009 Mar;11(3):181-6. doi: 10.1089/dia.2008.0048.
Control of serum glucose levels is essential for the reduction of complications of diabetes. Telemedicine is one strategy through which serum glucose control can be improved.
A total of 35 adult, insulin-treated patients with diabetes (type 1 and type 2) were enrolled in the present study (63.0 +/- 10 years of age, 63% female) and randomized to telemedicine monitoring (including cordless, remote glucose monitor, and transmitter, n = 17), or conventional follow-up (n = 18). Metabolic parameters were evaluated, and a quality of life questionnaire was administered both pre- and post-treatment.
Groups were similar at baseline in terms of demographic, quality of life, and metabolic parameters. Significant differences in post-treatment metabolic parameters were not observed, although serum glucose was marginally elevated in the control group compared to the telemedicine group (214 +/- 65 mg/dL vs. 171 +/- 77 mg/dL, P = 0.09). On the other hand, being clinically symptom-free (71% vs. 11%, P = 0.003), having no hypoglycemic events (82% vs. 17%, P = 0.0001), and having no hyperglycemic events (65% vs. 17%, P = 0.004) were all significantly more frequently reported in the telemedicine group compared to the control group. Compared to the control group, the telemedicine group reported experiencing significantly less anxiety, treatment difficulty, depression, disease-associated life complications, and feelings of impotence or ineptitude and significantly greater improvement in personal control over glucose, weight, and overall diabetes.
Though post-treatment metabolic differences were not observed between treatment groups, the telemedicine group reported significantly greater post-treatment experiences of improved quality of life and sense of control over the disease. Thus patient satisfaction can be enhanced through the use of telemedicine.
控制血糖水平对于减少糖尿病并发症至关重要。远程医疗是一种可改善血糖控制的策略。
本研究共纳入35例接受胰岛素治疗的成年糖尿病患者（1型和2型）（年龄63.0±10岁，63%为女性），随机分为远程医疗监测组（包括无线远程血糖监测仪和发射器，n = 17）或传统随访组（n = 18）。评估代谢参数，并在治疗前后进行生活质量问卷调查。
两组在人口统计学、生活质量和代谢参数方面基线相似。尽管与远程医疗组相比，对照组的血糖略有升高（214±65 mg/dL对171±77 mg/dL，P = 0.09），但治疗后代谢参数未观察到显著差异。另一方面，与对照组相比，远程医疗组报告临床无症状（71%对11%，P = 0.003）、无低血糖事件（82%对17%，P = 0.0001）和无高血糖事件（65%对17%，P = 0.004）的频率显著更高。与对照组相比，远程医疗组报告的焦虑、治疗困难、抑郁、疾病相关生活并发症以及阳痿或无能感显著更少，对血糖、体重和总体糖尿病的个人控制改善显著更大。
尽管治疗组之间未观察到治疗后代谢差异，但远程医疗组报告治疗后生活质量改善和疾病控制感显著更强。因此，使用远程医疗可提高患者满意度。
