2 型糖尿病患者的积极性和移动医疗干预措施降低了心血管疾病风险。

Type 2 diabetes patient activation and mHealth interventions decreased cardiovascular disease risk.

机构信息

Division of Internal Medicine, Department of Medicine, College of Human Medicine, Michigan State University, 788 Service Rd, B323 Clinical Center, East Lansing, MI 48824. Email:

出版信息

Am J Manag Care. 2022 Nov 1;28(11):e392-e398. doi: 10.37765/ajmc.2022.89263.

DOI:10.37765/ajmc.2022.89263

PMID:36374656

Abstract

OBJECTIVES

Cardiovascular disease (CVD) deaths in patients with type 2 diabetes (T2D) are 2 to 4 times higher than among those without T2D. Our objective was to determine whether a patient activation program (Office-Guidelines Applied to Practice [Office-GAP]) plus a mobile health (mHealth) intervention compared with mHealth alone improved medication use and decreased 10-year atherosclerotic CVD (ASCVD) risk score in patients with T2D.

STUDY DESIGN

Quasi-experimental design; Office-GAP plus mHealth vs mHealth only.

METHODS

The Office-GAP intervention included (1) a patient activation group visit, (2) provider training, and (3) a decision support checklist used in real time during the encounter. The mHealth intervention included daily text messages for 15 weeks. Patients with T2D (hemoglobin A1c ≥ 8%) attending internal medicine residency clinics were randomly assigned to either the combined Office-GAP + mHealth group (Green) or mHealth-only group (White). After group visits, patients followed up with providers at 2 and 4 months. A generalized estimating equation regression model was used to compare change in medication use and ASCVD risk scores between the 2 arms at 0, 2, and 4 months.

RESULTS

Fifty-one patients with diabetes (26 in Green team and 25 in White team) completed the study. The 10-year ASCVD risk score decreased in both groups (Green: -3.23; P = .06; White: -3.98; P = .01). Medication use increased from baseline to 4-month follow-up (statin: odds ratio [OR], 2.20; 95% CI, 1.32-3.67; aspirin: OR, 3.21, 95% CI, 1.44-7.17; angiotensin-converting enzyme inhibitor/angiotensin receptor blocker: OR, 2.67, 95% CI, 1.09-6.56). There was no significant difference in impact of the combined intervention (Office-GAP + mHealth) compared with mHealth alone.

CONCLUSIONS

Both Office-GAP + mHealth and mHealth alone increased the use of evidence-based medications and decreased 10-year ASCVD risk scores for patients with T2D in 4 months.

摘要

目的

2 型糖尿病（T2D）患者的心血管疾病（CVD）死亡率是无 T2D 患者的 2 至 4 倍。我们的目的是确定患者激活计划（Office-Guidelines Applied to Practice [Office-GAP]）联合移动医疗（mHealth）干预是否比单独使用 mHealth 能提高 T2D 患者的药物使用并降低 10 年动脉粥样硬化性 CVD（ASCVD）风险评分。

研究设计

准实验设计；Office-GAP 联合 mHealth 与 mHealth 单独比较。

方法

Office-GAP 干预包括（1）患者激活小组访问，（2）提供者培训，（3）在就诊期间实时使用决策支持清单。mHealth 干预包括为期 15 周的每日短信。参加内科住院医师诊所的 T2D 患者（糖化血红蛋白≥8%）被随机分配到联合 Office-GAP+mHealth 组（绿色）或 mHealth 单独组（白色）。小组访问后，患者在 2 个月和 4 个月时与提供者进行随访。使用广义估计方程回归模型比较两组在 0、2 和 4 个月时药物使用和 ASCVD 风险评分的变化。

结果

51 名糖尿病患者（绿色组 26 名，白色组 25 名）完成了研究。两组的 10 年 ASCVD 风险评分均降低（绿色组：-3.23；P=0.06；白色组：-3.98；P=0.01）。药物使用从基线到 4 个月随访时增加（他汀类药物：比值比[OR]，2.20；95%CI，1.32-3.67；阿司匹林：OR，3.21，95%CI，1.44-7.17；血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂：OR，2.67，95%CI，1.09-6.56）。联合干预（Office-GAP+mHealth）与单独使用 mHealth 相比，没有显著差异。