Population Informatics Lab, Texas A&M University, College Station, TX, United States.
Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.
J Med Internet Res. 2023 Aug 22;25:e45033. doi: 10.2196/45033.
The prevalence of diabetes in the United States is high and increasing, and it is also the most expensive chronic condition in the United States. Self-monitoring of blood glucose or continuous glucose monitoring are potential solutions, but there are barriers to their use. Remote patient monitoring (RPM) with appropriate support has the potential to provide solutions.
We aim to investigate the adherence of Medicaid patients with diabetes to daily RPM protocols, the relationship between adherence and changes in blood glucose levels, and the impact of daily testing time on blood glucose changes.
This retrospective cohort study analyzed real-world data from an RPM company that provides services to Texas Medicaid patients with diabetes. Overall, 180 days of blood glucose data from an RPM company were collected to assess transmission rates and blood glucose changes, after the first 30 days of data were excluded due to startup effects. Patients were separated into adherent and nonadherent cohorts, where adherent patients transmitted data on at least 120 of the 150 days. z tests and t tests were performed to compare transmission rates and blood glucose changes between 2 cohorts. In addition, we analyzed blood glucose changes based on their testing time-between 1 AM and 10 AM, 10 AM and 6 PM, and 6 PM and 1 AM.
Mean patient age was 70.5 (SD 11.8) years, with 66.8% (n=255) of them being female, 91.9% (n=351) urban, and 89% (n=340) from south Texas (n=382). The adherent cohort (n=186, 48.7%) had a mean transmission rate of 82.8% before the adherence call and 91.1% after. The nonadherent cohort (n=196, 51.3%) had a mean transmission rate of 45.9% before and 60.2% after. The mean blood glucose levels of the adherent cohort decreased by an average of 9 mg/dL (P=.002) over 5 months. We also found that variability of blood glucose level of the adherent cohort improved 3 mg/dL (P=.03) over the 5-month period. Both cohorts had the majority of their transmissions between 1 AM and 10 AM, with 70.5% and 53.2% for the adherent and nonadherent cohorts, respectively. The adherent cohort had decreasing mean blood glucose levels over 5 months, with the largest decrease during the 6 PM to 1 AM time period (30.9 mg/dL). Variability of blood glucose improved only for those tested from 10 AM to 6 PM, with improvements of 6.9 mg/dL (P=.02). Those in the nonadherent cohort did not report significant changes.
RPM can help manage diabetes in Medicaid clients by improving adherence rates and glycemic control. Adherence calls helped improve adherence rates, but some patients still faced challenges in transmitting blood glucose levels. Nonetheless, RPM has the potential to reduce the risk of adverse outcomes associated with diabetes.
美国的糖尿病患病率很高且呈上升趋势，它也是美国最昂贵的慢性病。自我监测血糖或连续血糖监测是潜在的解决方案，但它们的使用存在障碍。远程患者监测 (RPM) 与适当的支持相结合，具有提供解决方案的潜力。
我们旨在调查 Medicaid 糖尿病患者对每日 RPM 方案的依从性，以及依从性与血糖水平变化之间的关系，以及每日检测时间对血糖变化的影响。
这项回顾性队列研究分析了一家为德克萨斯州 Medicaid 糖尿病患者提供服务的 RPM 公司的真实世界数据。总共收集了 RPM 公司 180 天的血糖数据，以评估传输率和血糖变化，在排除前 30 天的数据（由于启动效应）后。患者被分为依从性和非依从性队列，其中依从性队列至少在 150 天中的 120 天中传输数据。进行 z 检验和 t 检验比较两个队列之间的传输率和血糖变化。此外，我们还根据检测时间（1 点至 10 点、10 点至 6 点和 6 点至 1 点）分析了血糖变化。
患者平均年龄为 70.5（SD 11.8）岁，其中 66.8%（n=255）为女性，91.9%（n=351）为城市居民，89%（n=340）来自德克萨斯州南部（n=382）。依从性队列（n=186，48.7%）在依从性电话前的平均传输率为 82.8%，之后为 91.1%。非依从性队列（n=196，51.3%）在依从性电话前的平均传输率为 45.9%，之后为 60.2%。依从性队列的平均血糖水平在 5 个月内平均降低了 9mg/dL（P=.002）。我们还发现，5 个月期间，依从性队列的血糖水平变异性改善了 3mg/dL（P=.03）。两个队列的大部分传输都发生在 1 点至 10 点之间，依从性队列和非依从性队列分别为 70.5%和 53.2%。依从性队列的平均血糖水平在 5 个月内呈下降趋势，在 6 点至 1 点时间段降幅最大（30.9mg/dL）。仅在从 10 点到 6 点检测的患者中观察到血糖变异性的改善，改善了 6.9mg/dL（P=.02）。非依从性队列的患者没有报告显著变化。
RPM 通过提高依从性和血糖控制水平，有助于管理 Medicaid 客户的糖尿病。依从性电话有助于提高依从性，但一些患者在传输血糖水平方面仍面临挑战。尽管如此，RPM 具有降低与糖尿病相关不良后果风险的潜力。
