Chen Lichin, Chuang Lee-Ming, Chang Chia-Hsiun, Wang Chiou-Shiang, Wang I-Ching, Chung Yufang, Peng Hui-Yu, Chen Hui-Chuen, Hsu Yu-Ling, Lin Yu-Sheng, Chen Huang-Jen, Chang Tieng-Chun, Jiang Yi-Der, Lee Hung-Chang, Tan Ching-Ting, Chang Hsin-Lu, Lai Feipei
Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.
J Med Internet Res. 2013 Dec 9;15(12):e266. doi: 10.2196/jmir.2699.
Self-management is an important skill for patients with diabetes, and it involves frequent monitoring of glucose levels and behavior modification. Techniques to enhance the behavior changes of diabetic patients have been developed, such as diabetes self-management education and telehealthcare. Although the patients are engaged in self-management activities, barriers to behavior changes remain and additional work is necessary to address the impact of electronic media and telehealthcare on patient self-care behaviors.
The aims of this study were to (1) explore the behaviors of diabetic patients interacting with online applications, (2) determine the impact of a telehealthcare program among 7 self-care behaviors of the patients, and (3) determine the changes in glycosylated hemoglobin (HbA1c) levels.
A telehealthcare program was conducted to assist the patients with 7 self-care activities. The telehealthcare program lasted for 18 months and included the use of a third-generation mobile telecommunications glucometer, an online diabetes self-management system, and a teleconsultant service. We analyzed the data of 59 patients who participated in the telehealthcare program and 103 who did not. The behavioral assessments and the HbA1c data were collected and statistically analyzed to determine whether the telehealthcare services had an impact on the patients. We divided the 18-month period into 3 6-month intervals and analyzed the parameters of patients assisted by the telehealthcare service at different time points. We also compared the results of those who were assisted by the telehealthcare service with those who were not.
There was a significant difference in monitoring blood glucose between the beginning and the end of the patient participation (P=.046) and between the overall period and the end of patient participation (P<.001). Five behaviors were significantly different between the intervention and control patients: being active (P<.001), healthy eating (P<.001), taking medication (P<.001), healthy coping (P=.02), and problem solving (P<.001). Monitoring of blood glucose was significantly different (P=.02) during the 6-12 month stage of patient participation between the intervention and control patients. A significant difference between the beginning and the 6-12 month stage of patient participation was observed for the mean value of HbA1c level (P=.02), and the differences between the overall HbA1c variability and the variability of each 6-month interval was also significant.
Telehealthcare had a positive effect on diabetic patients. This study had enhanced blood glucose monitoring, and the patients in the program showed improvements in glycemic control. The self-care behaviors affect patient outcomes, and the changes of behavior require time to show the effects.
自我管理是糖尿病患者的一项重要技能，包括频繁监测血糖水平和行为改变。已开发出增强糖尿病患者行为改变的技术，如糖尿病自我管理教育和远程医疗。尽管患者参与了自我管理活动，但行为改变的障碍依然存在，还需要进一步开展工作来解决电子媒体和远程医疗对患者自我护理行为的影响。
本研究的目的是：（1）探究糖尿病患者与在线应用程序交互的行为；（2）确定远程医疗项目对患者7种自我护理行为的影响；（3）确定糖化血红蛋白（HbA1c）水平的变化。
开展了一项远程医疗项目以协助患者进行7种自我护理活动。该远程医疗项目持续18个月，包括使用第三代移动通讯血糖仪、一个在线糖尿病自我管理系统和一项远程会诊服务。我们分析了59名参与远程医疗项目的患者以及103名未参与患者的数据。收集行为评估和HbA1c数据并进行统计分析，以确定远程医疗服务是否对患者有影响。我们将18个月的时间段分为3个6个月的间隔期，并分析了在不同时间点接受远程医疗服务协助的患者的参数。我们还比较了接受远程医疗服务协助的患者与未接受协助患者的结果。
患者参与前后在血糖监测方面存在显著差异（P = 0.046），在整个时间段与患者参与结束时也存在显著差异（P < 0.001）。干预组和对照组患者在5种行为上存在显著差异：积极活动（P < 0.001）、健康饮食（P < 0.001）、服药（P < 0.001）、健康应对（P = 0.02）和解决问题（P < 0.001）。在患者参与的6 - 12个月阶段，干预组和对照组患者在血糖监测方面存在显著差异（P = 0.02）。在患者参与开始时与6 - 12个月阶段之间，HbA1c水平的平均值存在显著差异（P = 0.02），并且总体HbA1c变异性与每个6个月间隔期的变异性之间也存在显著差异。
远程医疗对糖尿病患者有积极影响。本研究加强了血糖监测，项目中的患者在血糖控制方面有所改善。自我护理行为影响患者预后，行为改变需要时间才能显现效果。
