用于实施和评估自动化虚拟2型糖尿病自我管理教育的糖尿病参与和激活平台：随机对照试验

Diabetes Engagement and Activation Platform for Implementation and Effectiveness of Automated Virtual Type 2 Diabetes Self-Management Education: Randomized Controlled Trial.

作者信息

Sabo Roy, Robins Jo, Lutz Stacy, Kashiri Paulette, Day Teresa, Webel Benjamin, Krist Alex

机构信息

Virginia Commonwealth University, Richmond, VA, United States.

Privia Health, LLC, Arlington, VA, United States.

出版信息

JMIR Diabetes. 2021 Mar 29;6(1):e26621. doi: 10.2196/26621.

DOI:10.2196/26621

PMID:33779567

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8088852/

Abstract

BACKGROUND

Patients with type 2 diabetes require recommendations for self-management education and support.

OBJECTIVE

In this study, we aim to design the Diabetes Engagement and Activation Platform (DEAP)-an automated patient education tool integrated into primary care workflow-and examine its implementation and effectiveness.

METHODS

We invited patients aged 18-85 years with a hemoglobin A (HbA) level ≥8 to participate in a randomized controlled trial comparing DEAP with usual care. DEAP modules addressing type 2 diabetes self-management education and support domains were programmed into patient portals, each with self-guided educational readings, videos, and questions. Care teams received patient summaries and were alerted to patients with low confidence or requesting additional help. HbA, BMI, and systolic and diastolic blood pressure (DBP) were measured.

RESULTS

Out of the 680 patients invited to participate, 337 (49.5%) agreed and were randomized. All of the 189 intervention patients accessed the first module, and 140 patients (74.1%) accessed all 9 modules. Postmodule knowledge and confidence scores were high. Only 18 patients requested additional help from the care team. BMI was lower for intervention patients than controls at 3 months (31.7 kg/m vs 32.1 kg/m; P=.04) and 6 months (32.5 kg/m vs 33.0 kg/m; P=.003); improvements were even greater for intervention patients completing at least one module. There were no differences in 3- or 6-month HbA or blood pressure levels in the intent-to-treat analysis. However, intervention patients completing at least one module compared with controls had a better HbA level (7.6% vs 8.2%; P=.03) and DBP (72.3 mm Hg vs 75.9 mm Hg; P=.01) at 3 months.

CONCLUSIONS

The findings of this study concluded that a significant proportion of patients will participate in an automated virtual diabetes self-management program embedded into patient portals and health systems show promise in helping patients manage their diabetes, weight, and blood pressure.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02957721; https://clinicaltrials.gov/ct2/show/NCT02957721.

摘要

背景

2型糖尿病患者需要自我管理教育和支持方面的建议。

目的

在本研究中，我们旨在设计糖尿病参与和激活平台（DEAP）——一种集成到初级保健工作流程中的自动化患者教育工具——并检验其实施情况和有效性。

方法

我们邀请年龄在18 - 85岁、血红蛋白A（HbA）水平≥8%的患者参与一项随机对照试验，将DEAP与常规护理进行比较。将涉及2型糖尿病自我管理教育和支持领域的DEAP模块编程到患者门户网站中，每个模块都有自我指导的教育读物、视频和问题。护理团队会收到患者摘要，并收到关于信心低或请求额外帮助的患者的提醒。测量HbA、体重指数（BMI）以及收缩压和舒张压（DBP）。

结果

在受邀参与的680名患者中，337名（49.5%）同意并被随机分组。189名干预组患者均访问了第一个模块，140名患者（74.1%）访问了所有9个模块。模块学习后的知识和信心得分较高。只有18名患者向护理团队请求额外帮助。干预组患者在3个月时（31.7kg/m²对32.1kg/m²；P = 0.04）和6个月时（32.5kg/m²对33.0kg/m²；P = 0.003）的BMI低于对照组；对于完成至少一个模块的干预组患者，改善更为明显。在意向性分析中，3个月或6个月时的HbA或血压水平没有差异。然而，在3个月时，完成至少一个模块的干预组患者与对照组相比，HbA水平更好（7.6%对8.2%；P = 0.03），DBP更低（72.3mmHg对75.9mmHg；P = 0.01）。