Department of Pediatrics, University of California Davis, Sacramento, CA, United States.
Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA, United States.
Front Endocrinol (Lausanne). 2023 Feb 2;14:1063290. doi: 10.3389/fendo.2023.1063290. eCollection 2023.
Remote patient monitoring (RPM) holds potential to enable more individualized and effective care for patients with type 1 diabetes (T1D), but requires population analytics to focus limited clinical resources on patients most in need. We explored the feasibility of RPM from patient and provider standpoints using a commercially available data analytic platform ( Population Health) among a cohort of youth with T1D.
Patients aged 1-20 years with established T1D (≥12 months) and CGM use (≥3 months) were recruited to participate. Participants' CGM devices were connected to the app and linked to the research team's account during a one-month baseline period. This was followed by a six-month intervention period during which participants with >15% of glucose values >250 mg/dl or >5% of values <70 mg/dl each month were contacted with personalized diabetes management recommendations. Participants were surveyed about their experiences, and effects on glycemic control were estimated change in glucose management indicator (GMI) generated from CGM data at baseline and completion. Changes in time spent within various glucose ranges were also evaluated, and all glycemic metrics were compared to a non-randomized control group difference-in-difference regression, adjusting for baseline characteristics.
Remote data-sharing was successful for 36 of 39 participants (92%). Between 33%-66% of participants merited outreach each month, and clinician outreach required a median of 10 minutes per event. RPM was reported to be helpful by 94% of participants. RPM was associated with a GMI change of -0.25% (=0.047) for the entire cohort, and stratified analysis revealed greatest treatment effects among participants with baseline GMI of 8.0-9.4% (GMI change of -0.68%, =0.047; 19.84% reduction in time spent >250 mg/dl, =0.005).
This study demonstrates the feasibility of RPM for patients with T1D using a commercially available population health platform, and suggests that RPM with clinician-initiated outreach may be particularly beneficial for patients with suboptimal glycemic control at entry. However, larger randomized studies are needed to fully explore the glycemic impact of RPM.
https://clinicaltrials.gov/ct2/show/NCT04696640, identifier NCT04696640.
远程患者监测（RPM）有可能为 1 型糖尿病（T1D）患者提供更个性化和更有效的护理，但需要人群分析将有限的临床资源集中在最需要的患者身上。我们使用商业上可用的数据分析平台（Population Health）从患者和提供者的角度探讨了 RPM 的可行性，该平台在一组患有 T1D 的青年患者中进行了研究。
招募了年龄在 1-20 岁之间、有 T1D（≥12 个月）和 CGM （≥3 个月）使用史的患者参加研究。在一个月的基线期内，参与者的 CGM 设备连接到 应用程序并与研究团队的 账户相关联。随后，参与者中有>15%的血糖值>250mg/dl 或>5%的血糖值<70mg/dl 时，参与者将在六个月的干预期内每月接受个性化的糖尿病管理建议。参与者接受了关于他们体验的调查，并估计了 CGM 数据生成的血糖管理指标（GMI）的变化。在基线和完成时。还评估了不同血糖范围内的时间花费变化，并且所有血糖指标均与非随机对照 组进行了比较差异回归，调整了基线特征。
成功与 39 名参与者中的 36 名（92%）进行了远程数据共享。每月有 33%-66%的参与者需要获得外联，临床医生的外联需要中位数 10 分钟/事件。94%的参与者表示 RPM 很有帮助。RPM 与整个队列的 GMI 变化为-0.25%（=0.047）相关，分层分析显示基线 GMI 为 8.0-9.4%的参与者的治疗效果最大（GMI 变化为-0.68%，=0.047；>250mg/dl 的时间减少 19.84%，=0.005）。
这项研究使用商业上可用的人口健康平台证明了 RPM 对 T1D 患者的可行性，并表明 RPM 与临床医生发起的外联相结合，可能对血糖控制不佳的患者尤其有益。然而，需要更大规模的随机研究来充分探索 RPM 的血糖影响。
https://clinicaltrials.gov/ct2/show/NCT04696640，标识符 NCT04696640。
