Medical Service, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.
Diabetes Technol Ther. 2012 Nov;14(11):1060-7. doi: 10.1089/dia.2012.0137. Epub 2012 Sep 6.
Care management may improve the quality of diabetes care by enhancing contact between high-risk patients and their providers. This prospective, longitudinal, randomized trial sought to investigate whether telephone or online care management improves diabetes-related outcomes over time compared with usual care supplemented with Internet access and training.
One hundred fifty-one adult subjects with type 2 diabetes mellitus and an elevated hemoglobin A1c (A1c) level (≥8.5%) were randomly assigned to online care management (n=51), telephone-based care management (n=51), or Web training (n=49) groups. Online and telephone participants interacted with a care manager through a diabetes education and care management Web site and by telephone, respectively. The Web training group was provided with online diabetes self-management resources but no care management support. The primary outcome measure was A1c measured every 3 months for a year.
A1c declined significantly and substantially in all groups over 12 months. A1c declined linearly at a rate of 0.32% (P<0.0001) per quarter for the online group, 0.36% (P<0.0001) for the telephone group, and 0.41% for the Web training group (P<0.0001). The rate of change over time did not differ significantly among groups. The groups converged at 12 months with average absolute A1c difference of -1.5%. The number of interactions with care providers was not significantly associated with the change in A1c. Blood pressure, weight, lipid levels, and diabetes distress did not differ among groups over time.
Online, telephone-based care management, and Web training for diabetes patients with elevated A1c were each associated with a substantial improvement in A1c over a 1-year period. Internet access and training alone may be as effective as care management in patients with poorly controlled diabetes.
通过加强高危患者与提供者之间的联系，护理管理可能会提高糖尿病护理质量。这项前瞻性、纵向、随机试验旨在研究与常规护理相比，通过电话或在线护理管理是否会随着时间的推移改善与糖尿病相关的结果，常规护理辅以互联网接入和培训。
151 名患有 2 型糖尿病和糖化血红蛋白（A1c）升高（≥8.5%）的成年受试者被随机分配到在线护理管理组（n=51）、电话护理管理组（n=51）或网络培训组（n=49）。在线和电话组参与者通过糖尿病教育和护理管理网站以及电话与护理经理进行互动。网络培训组提供在线糖尿病自我管理资源，但不提供护理管理支持。主要观察指标为 12 个月内每 3 个月测量一次 A1c。
所有组在 12 个月内 A1c 显著且大幅下降。在线组每季度 A1c 下降 0.32%（P<0.0001），电话组下降 0.36%（P<0.0001），网络培训组下降 0.41%（P<0.0001）。组间随时间变化的速度无显著差异。12 个月时，各组平均绝对 A1c 差异为-1.5%。与 A1c 变化相关的与护理提供者的互动次数没有显著差异。血压、体重、血脂水平和糖尿病困扰在各组之间随时间推移没有差异。
患有 A1c 升高的糖尿病患者的在线、基于电话的护理管理和网络培训均与 A1c 在 1 年内显著改善相关。互联网接入和培训本身在控制不佳的糖尿病患者中可能与护理管理一样有效。
