Tourkmani Ayla M, Alharbi Turki J, Rsheed Abdulaziz M Bin, Alotaibi Azzam F, Aleissa Mohammed S, Alotaibi Sultan, Almutairi Amal S, Thomson Jancy, Alshahrani Ahlam S, Alroyli Hadil S, Almutairi Hend M, Aladwani Mashael A, Alsheheri Eman R, Sati Hyfaa Salaheldin, Aljuaid Budur, Algarzai Abdulaziz S, Alabood Abood, Bushnag Reuof A, Ghabban Wala, Albaik Muhammed, Aldahan Salah, Redda Dalia, Almalki Ahmed, Almousa Noura, Aljehani Mohammed, Alrasheedy Alian A
Family and Community Medicine Department, Chronic Illness Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Health Services, Ministry of Defense, Riyadh, Saudi Arabia.
Telemed Rep. 2024 Feb 19;5(1):46-57. doi: 10.1089/tmr.2024.0003. eCollection 2024.
Patients with uncontrolled type 2 diabetes mellitus (T2DM) require close follow-up, support, and education to achieve glycemic control, especially during the initiation or intensification of insulin therapy and self-care management. This study aimed to describe and evaluate the impact of implementing a hybrid model of in-person and telemedicine care and education on glycemic control for patients with uncontrolled T2DM (hemoglobin A1c [HbA1c] ≥9%) during the coronavirus disease pandemic.
This prospective multicenter-cohort pre-/post-intervention study was conducted on patients with uncontrolled T2DM. This study included three chronic illness centers affiliated with the Family and Community Medicine Department at Prince Sultan Military Medical City in Riyadh, Saudi Arabia. A hybrid model of in-person (onsite) and telemedicine care and education was developed. This involved implementing initial in-person care at the physicians' clinic and initial in-person education at the diabetes education clinic, followed by telemedicine services of tele-follow-ups, support, and education for an average 4-month follow-up period.
Of the enrolled 181 patients, more than half of the participants were women ( = 103, 56.9%). The mean age of participants (standard deviation) was 58.64 ± 11.23 years and the mean duration of diabetes mellitus was 13.80 ± 8.55 years. The majority of the patients ( = 144; 79.6%) were on insulin therapy. Overall, in all three centers, the hybrid model had significantly reduced HbA1c from 10.47 ± 1.23% to 7.87 ± 1.59% (mean difference of reduction 2.59% [95% confidence interval (CI) = 2.34-2.85%], < 0.001). At the level of each center, HbA1c was reduced significantly with mean differences of 3.17% (95% CI = 2.81-3.53%), 2.49% (95% CI = 1.92-3.06%), and 2.16% (95% CI = 1.76-2.57%) at centers A, B, and C, respectively (all < 0.001).
The findings showed that the hybrid model of in-person and telemedicine care and education effectively managed uncontrolled T2DM. Consequently, the role of telemedicine in diabetes management could be further expanded as part of routine diabetes care in primary settings to achieve better glycemic control and minimize nonessential in-person visits when appropriate.
2型糖尿病（T2DM）控制不佳的患者需要密切随访、支持和教育以实现血糖控制，尤其是在胰岛素治疗起始或强化以及自我护理管理期间。本研究旨在描述和评估在冠状病毒病大流行期间，实施面对面和远程医疗相结合的护理与教育模式对T2DM控制不佳（糖化血红蛋白[HbA1c]≥9%）患者血糖控制的影响。
本前瞻性多中心队列干预前后研究针对T2DM控制不佳的患者开展。该研究纳入了沙特阿拉伯利雅得苏丹王军事医疗城家庭与社区医学部下属的三个慢性病中心。开发了一种面对面（现场）和远程医疗相结合的护理与教育模式。这包括在医生诊所进行初始面对面护理，在糖尿病教育诊所进行初始面对面教育，随后进行远程随访、支持和教育的远程医疗服务，平均随访期为4个月。
在纳入的181例患者中，超过一半为女性（n = 103，56.9%）。参与者的平均年龄（标准差）为58.64±11.23岁，糖尿病平均病程为13.80±8.55年。大多数患者（n = 144；79.6%）接受胰岛素治疗。总体而言，在所有三个中心，混合模式使HbA1c从10.47±1.23%显著降至7.87±1.59%（平均降低差异为2.59%[95%置信区间（CI）= 2.34 - 2.85%]，P < 0.001）。在每个中心层面，A、B和C中心的HbA1c均显著降低，平均差异分别为3.17%（95% CI = 2.81 - 3.53%）、2.49%（95% CI = 1.92 - 3.06%）和2.16%（95% CI = 1.76 - 2.57%）（均P < 0.001）。
研究结果表明，面对面和远程医疗相结合的护理与教育模式有效管理了T2DM控制不佳的情况。因此，远程医疗在糖尿病管理中的作用可作为基层常规糖尿病护理的一部分进一步扩大，以实现更好的血糖控制，并在适当的时候尽量减少不必要的面对面就诊。
