Fonda Stephanie J, McMahon Graham T, Gomes Helen E, Hickson Sara, Conlin Paul R
Joslin Diabetes Center , Boston, Massachusetts, USA.
J Diabetes Sci Technol. 2009 Jan;3(1):117-24. doi: 10.1177/193229680900300113.
This article investigated how changes in diabetes distress relate to receiving care management through an Internet-based care management (IBCM) program for diabetes and level of participation in this program. Further, it examined the relationship between diabetes distress and changes in glycemic control.
We enrolled patients of the Veterans Affairs Boston Healthcare System with diabetes who had hemoglobin A1c (HbA1c) levels of ≥9.0%. Subjects were randomized to usual care (n=52) or IBCM (n=52) for 1 year. We measured diabetes distress at baseline and quarterly thereafter using the Problem Areas in Diabetes (PAID) questionnaire. Glycemic control was determined by baseline and quarterly HbA1c. For subjects randomized to IBCM, we measured participation by observing frequency and consistency of their usage of the IBCM patient portal over 12 months. Linear mixed models were used to analyze THE data.
PAID scores declined over time for both treatment groups. Among subjects randomized to IBCM, the decline in PAID scores over time was significant for sustained users of the IBCM patient portal but not for nonusers. Moreover, subjects whose usage of the patient portal was sustained throughout the study had lower PAID scores at baseline. With respect to changes in glycemic control, HbA1c reduced individual differences in PAID scores by 44%; a lower baseline HbA1c was associated with lower baseline PAID scores, and over time, the decrease in HbA1c was associated with further decreases in the PAID score.
Participation in IBCM varies by initial diabetes distress, with people with less distress participating more. For people who participate, IBCM further mitigates diabetes distress. There is also a relationship between achievements in glycemic control and subsequent lowering of diabetes distress. Future research should identify how to maximize fit between patient needs and the provisions of IBCM, with the aim of increasing patient engagement in the active management of their health using this care modality. A key to maximizing fit might be first addressing metabolic control aggressively and then using IBCM for sustainment of health.
本文研究了糖尿病困扰的变化如何与通过基于互联网的糖尿病护理管理（IBCM）计划接受护理管理以及该计划的参与程度相关。此外，还研究了糖尿病困扰与血糖控制变化之间的关系。
我们招募了波士顿退伍军人事务医疗系统中糖化血红蛋白（HbA1c）水平≥9.0%的糖尿病患者。将受试者随机分为常规护理组（n = 52）或IBCM组（n = 52），为期1年。我们在基线时以及之后每季度使用糖尿病问题领域（PAID）问卷测量糖尿病困扰。通过基线和每季度的HbA1c来确定血糖控制情况。对于随机分配到IBCM组的受试者，我们通过观察他们在12个月内使用IBCM患者门户网站的频率和一致性来测量参与度。使用线性混合模型分析数据。
两个治疗组的PAID评分均随时间下降。在随机分配到IBCM组的受试者中，IBCM患者门户网站的持续使用者的PAID评分随时间的下降具有显著性，而非使用者则不然。此外，在整个研究过程中持续使用患者门户网站的受试者在基线时的PAID评分较低。关于血糖控制的变化，HbA1c减少了PAID评分中44%的个体差异；较低的基线HbA1c与较低的基线PAID评分相关，并且随着时间的推移，HbA1c的降低与PAID评分的进一步降低相关。
参与IBCM的情况因初始糖尿病困扰程度而异，困扰较少的人参与度更高。对于参与的人来说，IBCM进一步减轻了糖尿病困扰。血糖控制的改善与随后糖尿病困扰的降低之间也存在关系。未来的研究应确定如何使患者需求与IBCM的提供达到最佳匹配，以提高患者使用这种护理模式积极管理自身健康的参与度。实现最佳匹配的一个关键可能是首先积极解决代谢控制问题，然后使用IBCM来维持健康。
