在跨专业内科诊所中为服务不足和少数族裔2型糖尿病患者进行连续血糖监测。

Continuous Glucose Monitoring for Underserved and Minority Patients with Type 2 Diabetes in an Interprofessional Internal Medicine Clinic.

作者信息

Bui Arden, Kim Jennifer

机构信息

University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.

Moses Cone Internal Medicine Clinic, Cone Health, Greensboro, NC.

出版信息

Innov Pharm. 2020 Dec 3;11(4). doi: 10.24926/iip.v11i4.3501. eCollection 2020.

DOI:10.24926/iip.v11i4.3501

PMID:34007653

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8127115/

Abstract

OBJECTIVE

Evaluate the impact of interprofessional continuous glucose monitoring (CGM) on glycemic control in underserved and minority patients with type 2 diabetes mellitus (T2DM).

METHODS

The IRB-approved, retrospective quasi-experimental study was conducted between August 2018 and August 2019 at an internal medicine residency clinic. Adult patients with diagnosed T2DM, an indication for CGM (hyperglycemia, hypoglycemia, and/or glycemic variability), and at least 10 consecutive days of CGM data were included. Patients who were pregnant and/or missed one or more clinic appointments were excluded. Patients were followed weekly over a 14-day period during which data from the CGM sensor were downloaded and interpreted by the interprofessional team. Interventions with shared decision-making were made at each visit.

RESULTS

Fifty-five patients were included, with a mean age of 61+11.2 years, 86% were of non-white race, and 56% were female. Average blood glucose levels decreased from 208.39 mg/dL at week 1 to 190.74 mg/dL at week 2, a 17.65 mg/dLreduction (p = 0.0281). Time within target range (70-180 mg/dL) increased by 6.16% (p = 0.0038), while time above range (>180 mg/dL) decreased by 5.5% (p = 0.0168). Average number of hypoglycemic events (readings <70 mg/dL) did not change significantly from week 1 to week 2 (2.94 vs. 3.64, p > 0.05). Of the 66 interventions made after week 1, 33% were made by the pharmacy team, 56% were made by the attending or resident physicians, and 11% were made by the dietician. Of 59 interventions made after week 2, 32% were made by the pharmacy team, 49% were made by the attending or resident physicians, and 19% were made by the dietician.

CONCLUSIONS

The interprofessional collaborative CGM service was associated with improvements in glucose control based on increased time within target range and reduced hyperglycemia, without increasing the risk of hypoglycemia or medication burden.

摘要

目的

评估跨专业连续血糖监测（CGM）对医疗服务不足的2型糖尿病（T2DM）少数族裔患者血糖控制的影响。

方法

这项经机构审查委员会批准的回顾性准实验研究于2018年8月至2019年8月在内科住院医师诊所进行。纳入确诊为T2DM、有CGM指征（高血糖、低血糖和/或血糖波动）且有至少连续10天CGM数据的成年患者。排除怀孕和/或错过一次或多次门诊预约的患者。在14天的时间里，每周对患者进行随访，在此期间，跨专业团队下载并解读CGM传感器的数据。每次随访时都进行共同决策的干预。

结果

共纳入55例患者，平均年龄为61±11.2岁，86%为非白人种族，56%为女性。平均血糖水平从第1周的208.39mg/dL降至第2周的190.74mg/dL，降低了17.65mg/dL（p=0.0281）。目标范围内时间（70-180mg/dL）增加了6.16%（p=0.0038），而高于范围时间（>180mg/dL）减少了5.5%（p=0.0168）。从第1周到第2周，低血糖事件（读数<70mg/dL）的平均次数没有显著变化（2.94次对3.64次，p>0.05）。在第1周后的66次干预中，33%由药房团队进行，56%由主治医生或住院医师进行，11%由营养师进行。在第2周后的59次干预中，32%由药房团队进行，49%由主治医生或住院医师进行，19%由营养师进行。