Garabedian Laura F, Ross-Degnan Dennis, LeCates Robert F, Wharam James F
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215, United States.
Prim Care Diabetes. 2019 Dec;13(6):549-555. doi: 10.1016/j.pcd.2019.03.010. Epub 2019 May 13.
Innovative mobile health technologies (mHealth) may facilitate self-management of blood glucose. This study evaluates uptake, use, and predictors of uptake and long-term use of a diabetes mHealth intervention, which comprises an FDA-approved mobile glucometer and nurse coaching, in a real-world setting.
n = 4438 commercially-insured adults with diabetes were recruited from 2014 to 2015 via an opt-in, phone-based process. In this post-only study, we obtained data on recruitment, glucometer use, demographics, and insurance and employer characteristics. We calculated percent uptake and reasons for unsuccessful recruitment. We used logistic regression to model predictors of uptake and survival analysis to examine duration of testing and predictors of discontinuation.
Of the recruited members, 556 (12.5%) signed up for the mHealth program and 324 (7.3%) began testing. Of those who did not sign up, the majority (70.6%) were unable to be reached by phone. Male (OR = 1.60, 95% CI: 1.25, 2.03) and Spanish-speaking (OR = 8.34, 95% CI: 5.40, 12.88) members were more likely to start testing. Two-thirds (66.2%) of those who started testing had a first test value that indicated hyperglycemia; 97% tested more than once and the median time between first and last test was 407 days. Older age was the only significant predictor of long-term use.
Although uptake of the mHealth program was low, most members who started testing had initial glucose values that indicated a need for better glucose management and the majority of patients engaged with the program for over a year. Male and Spanish-speaking members were more likely to initiate the program.
创新的移动健康技术（mHealth）可能有助于血糖的自我管理。本研究评估了一种糖尿病移动健康干预措施在实际环境中的采用情况、使用情况以及采用和长期使用的预测因素，该干预措施包括一台获得美国食品药品监督管理局（FDA）批准的移动血糖仪和护士指导。
2014年至2015年期间，通过基于电话的主动报名程序招募了n = 4438名参加商业保险的成年糖尿病患者。在这项仅进行事后分析的研究中，我们获取了有关招募、血糖仪使用、人口统计学以及保险和雇主特征的数据。我们计算了采用率以及招募未成功的原因。我们使用逻辑回归对采用的预测因素进行建模，并使用生存分析来检查测试持续时间和停药的预测因素。
在招募的成员中，556人（12.5%）报名参加了移动健康计划，324人（7.3%）开始进行测试。在未报名的人中，大多数（70.6%）无法通过电话联系到。男性（比值比[OR] = 1.60，95%置信区间[CI]：1.25，2.03）和说西班牙语的成员（OR = 8.34，95% CI：5.40，12.88）更有可能开始测试。开始测试的人中有三分之二（66.2%）的首次测试值表明患有高血糖；97%的人进行了不止一次测试，首次测试和最后一次测试之间的中位时间为407天。年龄较大是长期使用的唯一显著预测因素。
尽管移动健康计划的采用率较低，但大多数开始测试的成员的初始血糖值表明需要更好地管理血糖，并且大多数患者参与该计划超过一年。男性和说西班牙语的成员更有可能启动该计划。
