Université de Paris, Centre of Research in Epidemiology and Statistics, French National Institute of Health and Medical Research, National Institute for Agricultural Research, Paris, France.
Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
JAMA Netw Open. 2021 Jan 4;4(1):e2033115. doi: 10.1001/jamanetworkopen.2020.33115.
Patients will decide whether to adopt remote digital monitoring (RDM) for diabetes by weighing its health benefits against the inconvenience it may cause.
To identify the minimum effectiveness patients report they require to adopt 36 different RDM scenarios.
DESIGN, SETTING, AND PARTICIPANTS: This survey study was conducted among adults with type 1 or type 2 diabetes living in 30 countries from February to July 2019.
Survey participants assessed 3 randomly selected scenarios from a total of 36. Scenarios described different combinations of digital monitoring tools (glucose, physical activity, food monitoring), duration and feedback loops (feedback in consultation vs real-time telefeedback by a health care professional or by artificial intelligence), and data handling modalities (by a public vs private company), reflecting different degrees of RDM intrusiveness in patients' personal lives.
Participants assessed the minimum effectiveness for 2 diabetes-related outcomes (reducing hypoglycemic episodes and preventing ophthalmologic complications) for which they would adopt each RDM (from much less effective to much more effective than their current monitoring).
Of 1577 individuals who consented to participate, 1010 (64%; 572 [57%] women, median [interquartile range] age, 51 [37-63] years, 524 [52%] with type 1 diabetes) assessed at least 1 vignette. Overall, 2860 vignette assessments were collected. In 1025 vignette assessments (36%), participants would adopt RDM only if it was much more effective at reducing hypoglycemic episodes compared with their current monitoring; in 1835 assessments (65%), participants would adopt RDM if was just as or somewhat more effective. The main factors associated with required effectiveness were food monitoring (β = 0.32; SE, 0.12; P = .009), real-time telefeedback by a health care professional (β = 0.49; SE, 0.15; P = .001), and perceived intrusiveness (β = 0.36; SE, 0.06; P < .001). Minimum required effectiveness varied among participants; 34 of 36 RDM scenarios (94%) were simultaneously required to be just as or less effective by at least 25% of participants and much more effective by at least 25% of participants. Results were similar for participant assessments of scenarios regarding the prevention of ophthalmologic complications.
The findings of this study suggest that patients require greater health benefits to adopt more intrusive RDM modalities, food monitoring, and real-time feedback by a health care professional. Patient monitoring devices should be designed to be minimally intrusive. The variability in patients' requirements points to a need for shared decision-making.
患者将通过权衡远程数字监测（RDM）带来的健康益处与其可能带来的不便来决定是否采用这种监测方式。
确定患者报告的最低有效性，以采用 36 种不同的 RDM 方案。
设计、设置和参与者：本调查研究于 2019 年 2 月至 7 月在 30 个国家/地区的 1 型或 2 型糖尿病患者中进行。
调查参与者从总共 36 种情景中随机选择了 3 种情景进行评估。情景描述了不同的数字监测工具组合（血糖、身体活动、食物监测）、持续时间和反馈循环（咨询中的反馈与由医疗保健专业人员或人工智能提供的实时远程反馈），以及数据处理方式（由公共公司与私人公司），反映了 RDM 在患者个人生活中的不同侵入程度。
参与者评估了 2 项与糖尿病相关的结果（降低低血糖发作和预防眼科并发症）的最低有效性，他们将为每种 RDM （比当前监测更有效或更有效）采用 RDM。
在同意参加的 1577 人中，有 1010 人（64%；572[57%]名女性，中位数[四分位间距]年龄，51[37-63]岁，524[52%]为 1 型糖尿病）评估了至少 1 个情景。共收集了 2860 个情景评估。在 1025 个（36%）情景评估中，参与者只有在 RDM 降低低血糖发作的效果比当前监测明显更有效时，才会采用 RDM；在 1835 个（65%）评估中，只要 RDM 与当前监测一样有效或稍微有效，参与者就会采用 RDM。与所需有效性相关的主要因素是食物监测（β=0.32；SE，0.12；P=0.009）、医疗保健专业人员的实时远程反馈（β=0.49；SE，0.15；P=0.001）和感知的侵入性（β=0.36；SE，0.06；P<0.001）。参与者所需的最低有效性存在差异；36 种 RDM 方案中的 34 种（94%）同时需要至少 25%的参与者认为与当前监测一样有效或稍低，至少 25%的参与者认为 RDM 更有效。参与者对预防眼科并发症的情景评估的结果类似。
本研究结果表明，患者需要更大的健康益处才能采用更具侵入性的 RDM 模式、食物监测和医疗保健专业人员的实时反馈。患者监测设备应设计为最小侵入性。患者需求的变化表明需要共同决策。
