SUNY Upstate Medical University, Syracuse, New York 13214, USA.
Diabetes Technol Ther. 2010 Mar;12(3):213-20. doi: 10.1089/dia.2009.0102.
We examine the changes in waist circumference (WC) and body mass index (BMI) in older adults enrolled in a diabetes telemedicine program. The subjects were elderly Medicare beneficiaries participating in the rural (upstate New York) cohort of Informatics and Diabetes Education and Telemedicine, a randomized, controlled trial using telemedicine to improve diabetes care in which the primary outcome was glycemic control.
Ninety-two percent of the subjects had BMI >25 kg/m(2), and 65.8% had a BMI > or =30 kg/m(2). Intervention subjects received home televisits with a dietitian or nurse educator every 4-6 weeks. Blood glucose and blood pressure values were reviewed, and lifestyle and medication changes were recommended. Non-intervention subjects received usual care through their primary care physicians. Change in WC, BMI, diet, and exercise behaviors and knowledge were examined at baseline and 12 and 24 months. A mixed-effects path analysis was performed to examine direct and indirect effects.
The telemedicine participants increased diet and exercise knowledge over time (P < 0.001). It was estimated that women in the telemedicine group reduced their WC over the 2 years by 1.2 cm, whereas women in the usual care group increased their WC by almost 1 cm (P = 0.02). Path analysis demonstrated that the intervention, through improved diet and exercise knowledge, was related to the decrease in WC (P = 0.006) and BMI (P = 0.004).
Diabetes case management using telemedicine improved self-reported diet and exercise knowledge, practices, and behaviors, which in turn was associated with reductions in WC and BMI at 2 years.
我们研究了参加糖尿病远程医疗计划的老年人腰围（WC）和体重指数（BMI）的变化。这些受试者是参加农村（纽约州北部）信息学和糖尿病教育与远程医疗队列的老年医疗保险受益人，这是一项使用远程医疗改善糖尿病护理的随机对照试验，主要结果是血糖控制。
92%的受试者 BMI>25kg/m(2)，65.8%的受试者 BMI>或=30kg/m(2)。干预组每 4-6 周接受一次营养师或护士教育的家庭电视访问。审查了血糖和血压值，并建议改变生活方式和药物。非干预组通过初级保健医生接受常规护理。在基线、12 个月和 24 个月时检查 WC、BMI、饮食和运动行为以及知识的变化。采用混合效应路径分析来检验直接和间接效应。
远程医疗参与者随着时间的推移增加了饮食和运动知识（P < 0.001）。据估计，远程医疗组的女性在 2 年内腰围减少了 1.2 厘米，而常规护理组的女性腰围增加了近 1 厘米（P = 0.02）。路径分析表明，通过改善饮食和运动知识，干预与 WC（P = 0.006）和 BMI（P = 0.004）的降低有关。
使用远程医疗进行糖尿病病例管理提高了自我报告的饮食和运动知识、实践和行为，这反过来又与 2 年内 WC 和 BMI 的降低有关。
