SUNY Upstate Medical University, Syracuse, NY 13210, USA.
Telemed J E Health. 2013 Aug;19(8):643-5. doi: 10.1089/tmj.2012.0274. Epub 2013 Jun 12.
The objective of this study was to evaluate the feasibility of using telemedicine to improve glycemic control (reduce episodes of hypoglycemia and severe hyperglycemia) for residents with diabetes in a skilled nursing facility. This randomized pilot study enrolled residents with diabetes (n=23; mean age, 83 years; 91% insulin-treated) and compared usual care (control; n=11) with usual care plus weekly/biweekly teleconsultations with an endocrinologist (n=12) for up to 6 months. A nurse and dietitian from the skilled nursing facility were at all televisits. Residents who were able and willing attended the televisits. Family members were also invited and occasionally were present. The endocrinologist reviewed glucose levels from point-of-care glucose meter downloads, dietary intake, medications, and medical status and recommended changes in glycemic therapy as needed. Measurements included glucose levels from point-of-care glucose meter downloads, hemoglobin A1c (A1c) levels, and a nurse satisfaction survey. Results showed that 7 of 10 insulin-treated intervention subjects had basal doses reduced (18-69%) compared with 2 of 11 control subjects (reduced 10% and 25%, respectively). There was a decrease in percentage of intervention participants with episodes of hypoglycemia (<80 mg/dL) over the previous month from baseline (42%) to end of study (22%) versus a rise in the control group (from 36% to 45%) and less hyperglycemia (>400 mg/dL) (intervention, from 33% to 22%; control, from 22% to 55%). There were no end-of-study A1c values >8.0% in the intervention group versus 44% in controls. Nursing staff at the skilled nursing facility expressed high satisfaction. Results suggest that telemedicine diabetes consultations to skilled nursing facilities can improve glycemic management.
这项研究的目的是评估使用远程医疗改善疗养院糖尿病患者血糖控制（减少低血糖和严重高血糖发作）的可行性。这项随机试点研究纳入了 23 名患有糖尿病的居民（平均年龄 83 岁，91%接受胰岛素治疗），并比较了常规护理（对照组，n=11）与常规护理加每周/每两周与内分泌医生进行远程咨询（干预组，n=12），最长持续 6 个月。疗养院的护士和营养师全程参与电视访问。有能力和意愿的患者参加电视访问。家属也被邀请，偶尔会出席。内分泌医生通过即时血糖仪下载的血糖水平、饮食摄入、药物和医疗状况来审查，必要时建议改变血糖治疗方案。测量包括即时血糖仪下载的血糖水平、糖化血红蛋白（HbA1c）水平以及护士满意度调查。结果显示，与对照组相比，10 名接受胰岛素治疗的干预组中有 7 名患者的基础剂量降低（18-69%），而对照组中有 2 名（分别降低了 10%和 25%）。与对照组相比，干预组低血糖（<80mg/dL）发作次数在前一个月从基线（42%）下降到研究结束时（22%），而对照组则上升（从 36%到 45%），高血糖（>400mg/dL）发作次数也有所减少（干预组从 33%下降到 22%，对照组从 22%上升到 55%）。干预组中没有研究结束时 HbA1c 值>8.0%的患者，而对照组中有 44%。疗养院的护理人员满意度很高。结果表明，远程医疗糖尿病咨询可以改善疗养院的血糖管理。
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