Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Section of Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, Indiana.
Pediatr Diabetes. 2018 Jun;19(4):776-781. doi: 10.1111/pedi.12648. Epub 2018 Mar 4.
As adolescents gain autonomy, it remains important for parents to be involved with diabetes management to avoid deterioration in glycemic control. Technologies for self-monitoring of blood glucose (SMBG) allow for remote monitoring in real-time by parents. This research compared 3 strategies for improving SMBG and diabetes self-care in the short-term. These strategies were: (1) health information technology (HIT)-enhanced blood glucose meter that shared blood glucose data among patients, their parent, and care providers, and allowed for text messaging; (2) family-centered goal setting; and (3) a combination of (1) and (2).
One hundred twenty-eight participants enrolled; 97 adolescent-parent pairs attended clinic at 3-month intervals during the 6-month intervention. Differences between treatment groups were evaluated using analysis of variance (ANOVAs) for continuous variables and χ tests for frequencies. Within patient changes were evaluated using paired t tests.
Participants in the HIT-enhanced SMBG group had no change in mean glycosylated hemoglobin (HbA1c). Participants assigned to family-centered goal setting had a non-significant decrease in HbA1c of -0.3% (P = .26) from baseline to 6 months. Participants in the combined approach had a significant decrease in HbA1c of -0.6% (P = .02) from baseline to 3 months, but the decrease of -0.4% at 6 months was non-significant (P = .51). The change in HbA1c from baseline to 3 months was greater for the combined approach than for the HIT-enhanced SMBG (P = .05) or family-centered goal setting (P = .01).
Our data suggest that utilizing the family-centered goal setting strategy when implementing HIT-enhanced diabetes technology deserves further study.
随着青少年获得自主权，父母仍然需要参与糖尿病管理，以避免血糖控制恶化。自我监测血糖（SMBG）技术可使父母实时远程监测。本研究比较了 3 种短期改善 SMBG 和糖尿病自我护理的策略。这些策略包括：（1）增强型血糖仪，可在患者、其父母和医护人员之间共享血糖数据，并支持短信功能；（2）以家庭为中心的目标设定；以及（3）结合（1）和（2）。
共招募 128 名参与者；97 对青少年-父母在 6 个月干预期间每 3 个月到诊所就诊一次。采用方差分析（ANOVA）比较连续变量和 χ 检验比较频率差异。采用配对 t 检验评估患者内变化。
HIT 增强型 SMBG 组的平均糖化血红蛋白（HbA1c）无变化。分配到以家庭为中心的目标设定组的参与者，HbA1c 从基线到 6 个月下降了 0.3%（P=0.26），但无统计学意义。采用联合方法的参与者，HbA1c 从基线到 3 个月下降了 0.6%（P=0.02），但从基线到 6 个月下降 0.4%，无统计学意义（P=0.51）。从基线到 3 个月，联合方法的 HbA1c 变化大于 HIT 增强型 SMBG（P=0.05）或家庭为中心的目标设定（P=0.01）。
我们的数据表明，在实施 HIT 增强型糖尿病技术时，利用以家庭为中心的目标设定策略值得进一步研究。
