Quinn Charlene C, Sareh Patricia L, Shardell Michelle L, Terrin Michael L, Barr Erik A, Gruber-Baldini Ann L
Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, USA.
J Diabetes Sci Technol. 2014 Mar;8(2):362-370. doi: 10.1177/1932296813514503. Epub 2014 Feb 5.
Of adults with type 2 diabetes, 84% take antihyperglycemic medication. Successful treatment requires active monitoring and medication dose adjustment by health providers. The objective of this study was to determine how a mobile-phone-based coaching system for diabetes management influences physician prescribing behavior. This secondary data analysis is based on a cluster randomized clinical trial that reported patients provided with mobile self-management had reduction in glycated hemoglobin (HbA1c) of 1.9% over 1 year, compared to 0.7% in control patients (P < .001). Participants were primary care patients with type 2 diabetes randomized at physician practice level into a control group (n = 55) and intervention group (n = 62). Main study measures were patients' medication records (medication, dose, frequency, start and end date) abstracted at baseline and study end. Antihyperglycemic medications, including sulfonylureas or thiazolidinediones, and antihypertensive and antilipemic medications were analyzed. A higher percentage of patients in the intervention group had modification and intensification of incretin mimetics during the 1-year study period (9.7% vs 0.0% and 8.1% vs 0.0%, both P = .008). A higher percentage of patients in the intervention group had modification and intensification of metformin (24.2% vs 7.3%, P = .033). The overall difference in physician prescribing of oral antihyperglycemic medications was not statistically significant. Our results suggest mobile diabetes interventions can encourage physicians to modify and intensify antihyperglycemic medications in patients with type 2 diabetes. Differences in physician prescribing behavior were modest, and do not appear to be large enough to explain a 1.2% decrease in HbA1c.
在成年2型糖尿病患者中，84%服用抗高血糖药物。成功的治疗需要医疗服务提供者进行积极监测和调整药物剂量。本研究的目的是确定基于手机的糖尿病管理指导系统如何影响医生的处方行为。这项二次数据分析基于一项整群随机临床试验，该试验报告称，与对照组患者糖化血红蛋白（HbA1c）在1年内降低0.7%相比，接受移动自我管理的患者糖化血红蛋白降低了1.9%（P < .001）。参与者为2型糖尿病初级护理患者，在医生执业层面随机分为对照组（n = 55）和干预组（n = 62）。主要研究指标是在基线和研究结束时提取的患者用药记录（药物、剂量、频率、开始和结束日期）。分析了抗高血糖药物，包括磺脲类或噻唑烷二酮类药物，以及抗高血压和抗血脂药物。在1年的研究期间，干预组中更高比例的患者对肠促胰岛素类似物进行了调整和强化（分别为9.7%对0.0%和8.1%对0.0%，P均 = .008）。干预组中更高比例的患者对二甲双胍进行了调整和强化（24.2%对7.3%，P = .033）。医生开具口服抗高血糖药物的总体差异无统计学意义。我们的结果表明，移动糖尿病干预措施可鼓励医生对2型糖尿病患者调整和强化抗高血糖药物。医生处方行为的差异不大，似乎不足以解释HbA1c降低1.2%的原因。
