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:
Am J Manag Care. 2022 Nov 1;28(11):e392-e398. doi: 10.37765/ajmc.2022.89263.
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.
Quasi-experimental design; Office-GAP plus mHealth vs mHealth only.
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.
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.
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.
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。
准实验设计；Office-GAP 联合 mHealth 与 mHealth 单独比较。
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。
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。
在 4 个月内，Office-GAP+mHealth 和 mHealth 单独使用都增加了 T2D 患者基于证据的药物使用，并降低了 10 年 ASCVD 风险评分。
