Lieber Bryan A, Taylor Blake, Appelboom Geoff, Prasad Kiran, Bruce Sam, Yang Annie, Bruce Eliza, Christophe Brandon, Connolly E Sander
Department of Neurosurgery, New York University, New York, NY, USA; Cerebrovascular Laboratory, Columbia University, New York, NY, USA.
Department of Neurosurgery, Columbia University, 630 West 168th Street Suite 5-454, New York, NY 10032, USA; Columbia University, College of Physicians and Surgeons, New York, NY, USA; Cerebrovascular Laboratory, Columbia University, New York, NY, USA.
J Clin Neurosci. 2015 May;22(5):807-11. doi: 10.1016/j.jocn.2014.11.009. Epub 2015 Mar 16.
Monitoring glycemic control is useful not only in the primary prevention of stroke in diabetics, but also in the rehabilitation from and secondary prevention of stroke. In an often functionally and neurocognitively impaired population, however, poor compliance with treatment regimens is a major problem. Wireless, telemonitoring glucometers - often integrated into the patient's healthcare system - offer a solution to the compliance issue. We sought to evaluate the effectiveness of telemonitoring technologies in improving long-term glycemic control. A search on www.clinicaltrials.gov, using keywords such as "telemonitoring" and "self-care device" was performed, and five trials were identified that compared hemoglobin A1c (HbA1c) levels of a group receiving standard care (controls) to a group receiving a telemonitoring intervention. Four of the five studies showed a greater reduction in HbA1c in the intervention group compared to controls at 6 months, although only one was statistically significant. There was considerable heterogeneity between studies (I(2)=69.5%, p=0.02), and the random effects model estimated the aggregate effect size for mean difference in reduction of HbA1c levels to be 0.08% (95% confidence interval -0.12% to 0.28%), which was not statistically significant (p=0.42). The varying results may be due to specific factors in the trials that contributed to their large heterogeneity, and further trials are needed to support the role of telemonitoring in improving diabetes management in this population. Nonetheless, in the future telemonitoring may substantially help patients at risk of ischemic stroke and those who require close glucose monitoring.
监测血糖控制不仅对糖尿病患者中风的一级预防有用，而且对中风后的康复及二级预防也很有用。然而，在一个通常存在功能和神经认知障碍的人群中，治疗方案依从性差是一个主要问题。无线远程监测血糖仪（通常集成到患者的医疗保健系统中）为依从性问题提供了解决方案。我们试图评估远程监测技术在改善长期血糖控制方面的有效性。在www.clinicaltrials.gov上进行了搜索，使用了“远程监测”和“自我护理设备”等关键词，确定了五项试验，这些试验比较了接受标准护理的对照组与接受远程监测干预组的糖化血红蛋白（HbA1c）水平。五项研究中的四项显示，干预组在6个月时HbA1c的降低幅度大于对照组，尽管只有一项具有统计学意义。研究之间存在相当大的异质性（I(2)=69.5%，p=0.02），随机效应模型估计HbA1c水平降低的平均差异的总体效应大小为0.08%（95%置信区间为-0.12%至0.28%），无统计学意义（p=0.42）。结果的差异可能是由于试验中的特定因素导致了较大的异质性，需要进一步的试验来支持远程监测在改善该人群糖尿病管理中的作用。尽管如此，未来远程监测可能会极大地帮助有缺血性中风风险的患者以及那些需要密切监测血糖的患者。
