Lee Cia S, Tyagi Shilpa, Ling Koh Eileen Y, Gong Pei P, Ang Seng B, Gerald Koh Choon H, Tan Ngiap C
SingHealth Polyclinics, Singapore.
SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore.
J Telemed Telecare. 2025 Oct;31(9):1249-1259. doi: 10.1177/1357633X241261733. Epub 2024 Aug 1.
IntroductionTelehealth increases care accessibility to patients with type-2 diabetes mellitus but the duration of its implementation to sustain optimal glycaemic control remains unclear. This study aimed to assess the health outcomes of these patients using the Optimizing care of Patients via Telemedicine In Monitoring and aUgmenting their control of diabetes Mellitus (OPTIMUM) home tele-monitoring (HTM) system 6 months post-intervention, compared to standard care.MethodsAn open-labelled randomized controlled trial involving 330 participants with type-2 diabetes mellitus, aged 26-65 years, and suboptimal glycaemic control (HbA1c = 7.5%-10%) was conducted. Intervention group received OPTIMUM HTM for 6 months followed by usual care for another 6 months, while control group received usual care for 12 months. OPTIMUM HTM includes in-app video-based tele-education, tele-monitoring of the blood pressure, capillary glucose and weight via Bluetooth devices and mobile applications, followed by algorithm-based tele-management by the OPTIMUM HTM team. Assessments using self-care inventory scale and medication adherence were administered for both groups at baseline, 6-month, and 12-month timepoints.ResultsComplete data from 156 (intervention) and 159 (control) participants, with comparable demographic profiles, were analysed. Both groups showed a significant reduction in HbA1c from baseline ( < 0.001). From 6-month to 12-month time-points, the intervention group was twice as likely to maintain their HbA1c ≤ 8% (adjusted odds ratio = 2.02, 95%CI = 1.18-3.49; < 0.011). The intervention group demonstrated higher scores for self-care behaviours (adjusted odds ratio = 3.83 [95%CI = 1.68-5.97], = 0.001) and not skipping medications (adjusted odds ratio = 2.32 [95%CI = 1.09-4.97], = 0.030) at 12 months.DiscussionThe OPTIMUM HTM system enabled patients to maintain their glycaemic control beyond the intervention period. The favourable outcomes could be the effect of telehealth in sustaining self-care behaviour and medication adherence.
引言
远程医疗增加了2型糖尿病患者获得医疗服务的机会，但实施该服务以维持最佳血糖控制的持续时间仍不明确。本研究旨在通过远程医疗优化患者监测及增强糖尿病控制（OPTIMUM）家庭远程监测（HTM）系统，评估干预6个月后这些患者的健康结局，并与标准护理进行比较。
方法
开展了一项开放标签随机对照试验，纳入330名年龄在26 - 65岁、血糖控制不佳（糖化血红蛋白[HbA1c]=7.5%-10%）的2型糖尿病患者。干预组接受OPTIMUM HTM 6个月，随后接受6个月的常规护理，而对照组接受12个月的常规护理。OPTIMUM HTM包括应用内基于视频的远程教育、通过蓝牙设备和移动应用程序远程监测血压、毛细血管血糖和体重，随后由OPTIMUM HTM团队进行基于算法的远程管理。在基线、6个月和12个月时间点对两组患者使用自我护理量表和药物依从性进行评估。
结果
分析了156名（干预组）和159名（对照组）具有可比人口统计学特征的参与者的完整数据。两组糖化血红蛋白水平均较基线显著降低（P<0.001）。从6个月到12个月时间点，干预组糖化血红蛋白水平维持在≤8%的可能性是对照组的两倍（调整后的优势比=2.02，95%置信区间=1.18 - 3.49；P<0.011）。干预组在12个月时自我护理行为得分更高（调整后的优势比=3.83[95%置信区间=1.68 - 5.97]，P=0.001），且不遗漏服药的比例更高（调整后的优势比=2.32[95%置信区间=1.09 - 4.97]，P=0.030）。
讨论
OPTIMUM HTM系统使患者在干预期后仍能维持血糖控制。这些良好结果可能是远程医疗在维持自我护理行为和药物依从性方面的作用。
