Prætorius Thim, Baymler Lundberg Anne Sofie, Klausen Fredslund Eskild, Blach Rossen Niklas, Gregersen Søren, Prior Anders, Søndergaard Esben, Tang Knudsen Søren, Sandbæk Annelli
Steno Diabetes Center Aarhus, Aarhus University hospital, Aarhus, Denmark.
Department of Public Health, Aarhus University, Aarhus, Denmark.
NPJ Digit Med. 2025 Mar 28;8(1):179. doi: 10.1038/s41746-025-01570-w.
Although promising, the clinical impact of video conferencing between primary and secondary care specialists lacks trial evidence. We conducted a two-arm RCT (clinicaltrials.gov: NCT05268081) to evaluate whether four video conferences over 12 months between endocrinologists and general practitioners improved medication for people with type 2 diabetes (T2D). Twenty-seven of 100 general practices in Aarhus, Denmark were matched and randomized. Primary outcomes: the proportion of people with T2D and 1) ischemic heart disease treated with glucagon-like peptide 1 receptor agonist (GLP1-RA) and/or sodium glucose cotransporter 2 inhibitor (SGLT2I), 2) micro/macro-albuminuria treated with angiotensin-converting-enzyme-inhibitor (ACE) or angiotensin-2-receptorantagonist (AT2), 3) low-density lipoprotein >2.5 mmol/L treated with statins. Results showed a 17.6% difference [95% CI 4.6%; 30.7%] in GLP1-RA/SGLT2I prescriptions and minimal differences for ACE/AT2 (-1.1% [95% CI -2.8%; 0.6%]) and statins (0.0% [95% CI -3.5%; 3.6%]), attributed to a ceiling effect. Video conferencing can help bridge treatment gaps, particularly for recently updated guidelines.
尽管前景乐观，但初级和二级护理专家之间视频会议的临床影响缺乏试验证据。我们进行了一项双臂随机对照试验（clinicaltrials.gov：NCT05268081），以评估内分泌科医生和全科医生在12个月内进行的四次视频会议是否能改善2型糖尿病（T2D）患者的药物治疗。丹麦奥胡斯的100家全科诊所中的27家进行了匹配和随机分组。主要结局指标：T2D患者中1）使用胰高血糖素样肽1受体激动剂（GLP1-RA）和/或钠-葡萄糖协同转运蛋白2抑制剂（SGLT2I）治疗缺血性心脏病的比例，2）使用血管紧张素转换酶抑制剂（ACE）或血管紧张素2受体拮抗剂（AT2）治疗微量/大量白蛋白尿的比例，3）使用他汀类药物治疗低密度脂蛋白>2.5 mmol/L的比例。结果显示，GLP1-RA/SGLT2I处方的差异为17.6%[95%置信区间4.6%；30.7%]，而ACE/AT2（-1.1%[95%置信区间-2.8%；0.6%]）和他汀类药物（0.0%[95%置信区间-3.5%；3.6%]）的差异最小，这归因于天花板效应。视频会议有助于弥合治疗差距，特别是对于最近更新的指南。
