Greenwood Deborah A, Young Heather M, Quinn Charlene C
Betty Irene Moore School of Nursing at University of California Davis, Sacramento, CA, USA
Betty Irene Moore School of Nursing at University of California Davis, Sacramento, CA, USA.
J Diabetes Sci Technol. 2014 Mar;8(2):378-389. doi: 10.1177/1932296813519311. Epub 2014 Feb 21.
The aim was to summarize research on telehealth remote patient monitoring interventions that incorporate key elements of structured self-monitoring of blood glucose (SMBG) identified as essential for improving A1C. A systematic review was conducted using the Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and OVID Medline databases with search terms "Telemedicine" AND "Monitoring, Physiologic" AND "Diabetes Mellitus, Type 2." Study selection criteria included original randomized clinical trials evaluating the impact of telehealth remote patient monitoring on A1C among adults with type 2 diabetes and incorporated 1 or more essential elements of SMBG identified by the International Diabetes Federation (patient education, provider education, structured SMBG profile, SMBG goals, feedback, data used to modify treatment, interactive communication or shared decision making). Fifteen studies were included, with interventions ranging from 3 to 12 months (mean 8 months) with sample sizes from 30 to 1665. Key SMBG elements were grouped into 3 categories: education, SMBG protocols, and feedback. Research incorporating 5 of the 7 elements consistently achieved significant A1C improvements between study groups. Interventions using more SMBG elements are associated with an improvement in A1C. Studies with the largest A1C decrease incorporated 6 of the 7 elements and computer decision support. Two studies with 5 of the 7 elements and active medication management achieved significant A1C decreases. Telehealth remote patient monitoring interventions in type 2 diabetes have not included all structured monitoring elements recommended by the IDF. Incorporating more elements of structured SMBG is associated with improved A1C.
本研究旨在总结远程医疗远程患者监测干预措施的相关研究，这些干预措施纳入了结构化血糖自我监测（SMBG）的关键要素，而这些要素被认为对改善糖化血红蛋白（A1C）至关重要。我们使用Medline、护理及相关健康文献累积索引、EMBASE和OVID Medline数据库进行了一项系统评价，检索词为“远程医疗”、“生理监测”和“2型糖尿病”。研究选择标准包括评估远程医疗远程患者监测对2型糖尿病成年患者A1C影响的原始随机临床试验，且纳入了国际糖尿病联盟确定的SMBG的1个或多个基本要素（患者教育、医护人员教育、结构化SMBG档案、SMBG目标、反馈、用于调整治疗的数据、互动沟通或共同决策）。共纳入15项研究，干预时间为3至12个月（平均8个月），样本量为30至1665。关键的SMBG要素分为3类：教育、SMBG方案和反馈。纳入7项要素中5项的研究在研究组之间始终实现了A1C的显著改善。使用更多SMBG要素的干预措施与A1C的改善相关。A1C降低幅度最大的研究纳入了7项要素中的6项以及计算机决策支持。两项纳入7项要素中5项并进行积极药物管理的研究实现了A1C的显著降低。2型糖尿病的远程医疗远程患者监测干预措施未包括国际糖尿病联盟推荐的所有结构化监测要素。纳入更多结构化SMBG要素与A1C的改善相关。
