Littman Alyson J, Timmons Andrew K, Korpak Anna, Chan Kwun C G, Jones Kenneth T, Shirley Suzanne, Nordrum Kyle, Robbins Jeffrey, Masadeh Suhail, Moy Ernest
Seattle ERIC, VA Puget Sound Health Care System, 1660 S Columbian Way, S-152E, Seattle, WA, 98108, United States, 1 206-277-4182.
Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States.
JMIR Diabetes. 2024 Nov 5;9:e53083. doi: 10.2196/53083.
In-home remote foot temperature monitoring (RTM) holds promise as a method to reduce foot ulceration in high-risk patients with diabetes. Few studies have evaluated adherence to this method or evaluated the factors associated with noncompliance.
The aims of this study were to estimate noncompliance in patients who were enrolled in RTM nationwide across Department of Veterans Affairs (VA) and to evaluate characteristics associated with noncompliance.
We conducted an observational study including 1137 patients in the VA who were enrolled in RTM between January 2019 and June 2021, with follow-up through October 2021. Patient information was obtained from the VA's electronic health record and RTM use was obtained from the company. Noncompliance was defined as using the mat <2 days per week for ≥4 of the 12 months of follow-up. Using a multivariable model, we calculated odds ratios (ORs) and 95% CIs for associations between various factors and noncompliance and compared using Akaike information criterion statistics, a measure of model fit.
The sample was predominantly male (n=1125, 98.94%) ; 21.1% (n=230) were Black and 75.7% (n=825) were White. Overall, 37.6% (428/1137) of patients were classified as noncompliant. In the multivariable model, an intermediate area deprivation index was statistically significantly and inversely associated with noncompliance (area deprivation index 50-74 vs 1-24; OR 0.56, 95% CI 0.35-0.89); factors significantly and positively associated with noncompliance included recent history of osteomyelitis (OR 1.44, 95% CI 1.06-1.97), Gagne comorbidity index score ≥4 (vs ≤0; OR 1.81, 95% CI 1.15-2.83), telehealth encounters (28+ vs <6; OR 1.70, 95% CI 1.02-2.84), hemoglobin A1c≥10 (vs <5.7; OR 2.67, 95% CI 1.27-5.58), and current smoking (OR 2.06, 95% CI 1.32-3.20). Based on Akaike information criterion differences, the strongest factors associated with noncompliance were behavioral factors (poor glucose control [as measured by hemoglobin A1c] and smoking), and to a lesser extent, factors such as a recent history of osteomyelitis and an elevated Gagne comorbidity index, indicating a high comorbidity burden.
To reduce the risk of ulcer recurrence and amputation, proactively providing additional support for self-monitoring to patients with characteristics identified in this study (poor glucose control, current smoking, high comorbidity burden) may be helpful. Furthermore, research is needed to better understand barriers to use, and whether the addition of design features, reminders, or incentives may reduce noncompliance and the risk of foot ulcers.
家庭远程足部温度监测（RTM）有望成为一种减少糖尿病高危患者足部溃疡的方法。很少有研究评估对该方法的依从性或评估与不依从相关的因素。
本研究的目的是估计在退伍军人事务部（VA）全国范围内参加RTM的患者的不依从情况，并评估与不依从相关的特征。
我们进行了一项观察性研究，纳入了2019年1月至2021年6月期间在VA参加RTM的1137名患者，并随访至2021年10月。患者信息从VA的电子健康记录中获取，RTM使用情况从公司获取。不依从定义为在12个月的随访中，每周使用垫子<2天的时间≥4周。使用多变量模型，我们计算了各种因素与不依从之间关联的比值比（OR）和95%置信区间（CI），并使用赤池信息准则统计量进行比较，这是一种模型拟合度的度量。
样本以男性为主（n = 1125，98.94%）；21.1%（n = 230）为黑人，75.7%（n = 825）为白人。总体而言，37.6%（428/1137）的患者被归类为不依从。在多变量模型中，中等区域贫困指数与不依从在统计学上显著负相关（区域贫困指数50 - 74与1 - 24相比；OR 0.56，95% CI 0.35 - 0.89）；与不依从显著正相关的因素包括近期骨髓炎病史（OR 1.44，95% CI 1.06 - 1.97）、加涅合并症指数评分≥4（与≤0相比；OR 1.81，95% CI 1.15 - 2.83）、远程医疗会诊（28次及以上与<6次相比；OR 1.70，95% CI 1.02 - 2.84）、糖化血红蛋白≥10（与<5.7相比；OR 2.67，95% CI 1.27 - 5.58）以及当前吸烟（OR 2.06，95% CI 1.32 - 3.20）。基于赤池信息准则差异，与不依从相关最强的因素是行为因素（血糖控制不佳[以糖化血红蛋白衡量]和吸烟），在较小程度上，还有近期骨髓炎病史和加涅合并症指数升高，表明合并症负担较高等因素。
为降低溃疡复发和截肢风险，对具有本研究中所确定特征（血糖控制不佳、当前吸烟、合并症负担高）的患者积极提供额外的自我监测支持可能会有所帮助。此外，需要进行研究以更好地理解使用障碍，以及增加设计特点、提醒或激励措施是否可以减少不依从和足部溃疡风险。
