新型应用程序和网络支持的糖尿病预防计划，以促进体重减轻、体育活动和更健康的生活方式：临床应用观察
Novel App- and Web-Supported Diabetes Prevention Program to Promote Weight Reduction, Physical Activity, and a Healthier Lifestyle: Observation of the Clinical Application.
作者信息
Arens Johann H, Hauth Wolfgang, Weissmann Joerg
机构信息
1 Hausarzt-Zentrum Brüggen, Brüggen, Germany.
2 Facharztzentrum Rheinhessen, Alzey, Germany.
出版信息
J Diabetes Sci Technol. 2018 Jul;12(4):831-838. doi: 10.1177/1932296818768621. Epub 2018 Mar 27.
BACKGROUND
The increasing incidence of type 2 diabetes mellitus presents as a tsunami of health problems and health care costs. Preventing this development needs to target the underlying rise in metabolic syndrome cases through obesity and unhealthy lifestyle. Obesity is frequently perceived as a social issue with implicit psychological strain; health apps/weight-reduction programs are mushrooming from this side. The present program intends to bring weight reduction into the hands of HCPs by utilizing advanced digital technology.
METHODS
The prospective observational study analyzed 166 patients with metabolic syndrome as treated for weight reduction in 23 medical practices in Germany. Two approaches were observed: usual care (UC; n = 57) and a personalized health management program (PHM; n = 109). Key for PHM was the interaction between HCP and patient: reinforcing lifestyle changes through personalized goals and HCP-feedback via app- and web-based communication. Comparing PHM/UC was based on a time-to-success (5% weight reduction) analysis by Cox regression. Further exploratory analyses addressed the comparison of achievers and nonachievers.
RESULTS
Cox regression adjusted for sex, age, and BMI revealed a chance ratio for weight reduction of 6.2 (2.4-16.2, p = .0003) favoring PHM. Expected success rates were 44.8% for PHM, 11.5% for UC. PHM achievers reduced their weight by 8.0% and lowered their BMI by 2.7 points. Motivation for lifestyle changes represented a key for success.
CONCLUSIONS
The approach of enhanced interaction of HCPs and patients via app- and web-based communication was a clear success and delivered favorable responder rates. Treating obesity from a medical viewpoint will help to deepen the motivation for changing lifestyles. The study represents a cornerstone for a wider scoped application of these novel digital health approaches.
背景
2型糖尿病发病率的不断上升呈现为一场健康问题和医疗成本的海啸。预防这种发展需要针对因肥胖和不健康生活方式导致的代谢综合征病例的潜在增加。肥胖常常被视为一个带有隐性心理压力的社会问题；从这方面来看，健康应用程序/减肥计划如雨后春笋般涌现。本计划旨在通过利用先进的数字技术，将减肥的主动权交到医疗保健专业人员手中。
方法
这项前瞻性观察性研究分析了德国23家医疗机构中接受减肥治疗的166例代谢综合征患者。观察了两种方法：常规护理（UC；n = 57）和个性化健康管理计划（PHM；n = 109）。PHM的关键在于医疗保健专业人员与患者之间的互动：通过个性化目标强化生活方式改变，并通过基于应用程序和网络的通信提供医疗保健专业人员的反馈。比较PHM/UC基于通过Cox回归进行的成功时间（体重减轻5%）分析。进一步的探索性分析涉及成功者与未成功者的比较。
结果
对性别、年龄和BMI进行调整后的Cox回归显示，有利于PHM的体重减轻机会比为6.2（2.4 - 16.2，p = .0003）。PHM的预期成功率为44.8%，UC为11.5%。PHM成功者体重减轻了8.0%，BMI降低了2.7个点。生活方式改变的动机是成功的关键。
结论
通过基于应用程序和网络的通信增强医疗保健专业人员与患者之间互动的方法取得了明显成功，并产生了良好的反应率。从医学角度治疗肥胖将有助于加深改变生活方式的动机。该研究是这些新型数字健康方法更广泛应用的基石。
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