Turner Jane, Larsen Mark, Tarassenko Lionel, Neil Andrew, Farmer Andrew
National Institute of Health Research (NIHR) School of Primary Care Research, Department of Primary Health Care, University of Oxford, Oxford, UK.
Inform Prim Care. 2009;17(1):47-53. doi: 10.14236/jhi.v17i1.714.
Initiating and adjusting insulin treatment for people with type 2 diabetes (T2D) requires frequent clinician contacts both face-to-face and by telephone. We explored the use of a telehealth system to offer additional support to these patients.
Twenty-three patients with uncontrolled T2D were recruited from nine general practices to assess the feasibility and acceptability of telehealth monitoring and support for insulin initiation and adjustment. The intervention included a standard algorithm for self-titration of insulin dose, a Bluetooth enabled glucose meter linked to a mobile phone, an integrated diary to record insulin dose, feedback of charted blood glucose data and telehealth nurse review with telephone follow-up. Additional contact with patients was initiated when no readings were transmitted for >3 days or when persistent hyper- or hypoglycaemia was identified. Reponses of patients and clinicians to the system were assessed informally.
The mean (SD) patient age was 58 years (12) with 78% male. The mean (SD) diabetes duration was 6.4 years (4.5), HbA1c at baseline was 9.5% (2.2), and the decrease in HbA1c at three months was 0.52% (0.91) with an insulin dose increase of 9 units (26). A mean (SD) of 160 (93) blood glucose readings was transmitted per patient in these three months. Practice nurses and general practitioners (GPs) viewed the technology as having the potential to improve patient care. Most patients were able to use the equipment with training and welcomed review of their blood glucose readings by a telehealth nurse.
Although the concept of telehealth monitoring is unfamiliar to most patients and practice nurses, the technology improved the support available for T2D patients commencing insulin treatment.
启动和调整2型糖尿病（T2D）患者的胰岛素治疗需要临床医生与患者频繁进行面对面和电话联系。我们探索了使用远程医疗系统为这些患者提供额外支持。
从9家全科诊所招募了23名T2D控制不佳的患者，以评估远程医疗监测以及对胰岛素起始和调整提供支持的可行性和可接受性。干预措施包括胰岛素剂量自我滴定的标准算法、与手机相连的蓝牙血糖仪、记录胰岛素剂量的综合日记、绘制血糖数据的反馈以及远程医疗护士通过电话随访进行的评估。当超过3天未传输读数或发现持续高血糖或低血糖时，会与患者进行额外联系。对患者和临床医生对该系统的反应进行了非正式评估。
患者的平均（标准差）年龄为58岁（12岁），男性占78%。糖尿病平均（标准差）病程为6.4年（4.5年），基线时糖化血红蛋白（HbA1c）为9.5%（2.2%），三个月时HbA1c下降了0.52%（0.91%），胰岛素剂量增加了9单位（26单位）。在这三个月中，每位患者平均（标准差）传输了160次（93次）血糖读数。执业护士和全科医生（GPs）认为该技术有改善患者护理的潜力。大多数患者经过培训后能够使用该设备，并欢迎远程医疗护士对其血糖读数进行评估。
尽管大多数患者和执业护士对远程医疗监测的概念并不熟悉，但该技术改善了开始胰岛素治疗的T2D患者可获得的支持。
