Caballero Mateos Irene, Morales Portillo Cristóbal, Lainez López María, Vilches-Arenas Ángel
Endocrinology and Nutrition Department, Vithas Hospital, Sevilla, Spain.
Endocrinology and Nutrition Department, Juan Ramón Jiménez University Hospital, Huelva, Spain.
J Med Internet Res. 2025 Apr 10;27:e60758. doi: 10.2196/60758.
BACKGROUND: Adherence to therapies and metabolic control among patients with type 2 diabetes mellitus (T2DM) remain challenging. The use of new technologies, such as telemedicine, digitalized systems, and social networks, could improve self-management and disease control. OBJECTIVE: We evaluated the efficacy of a digital educational intervention for patients with T2DM, expressed as changes in glycated hemoglobin (HbA) and body composition and evaluation of the response using validated questionnaires of satisfaction with health care professionals (Instrument for Evaluation of the Experience of Chronic Patients), Diabetes Knowledge Scale (ECODI), and adherence to treatment over 6 months of follow-up (Morisky, Green, Levine Medication Assessment Questionnaire). METHODS: This multicenter, randomized, prospective study included adults with T2DM with poor metabolic control who started treatment with glucagon-like peptide-1 receptor agonists. Patients were randomized to digital intervention or usual care. The intervention group received education through social networks and digital tools in a structured program of healthy lifestyle changes. This was provided by a "Digital Coach" for weekly and on-demand advice and individualized support. Baseline and follow-up demographic, clinical parameter, adherence, and quality of life data were collected. RESULTS: We included 85 patients (control: n=41; intervention: n=44). Both groups were matched regarding demographics, physical examination, insulin, and biochemical parameters. We observed a reduction in body weight (intervention: -8.7, SD 6.1 kg vs control: -4.9, SD 5.0 kg; t=-3.13; P=.002), BMI (intervention: -3.0, SD 2.1 kg/m vs control: -1.8, SD 1.8 kg/m; t=-2.82; P=.006), and fast mass in both groups but greater in the intervention group. There were greater reductions in fasting plasma glucose (intervention: 122.6, SD 81.5 mg/dL vs control: 70.5, SD 72.9 mg/dL; t=3.10; P=.004) and HbA (intervention: 3.7%, SD 1.9% vs control: 2.6%, SD 2.1%; t=2.54; P=.006) in the intervention group. Although there was no significant change in the Spanish version of the Diabetes Quality of Life Questionnaire (EsDQOL) satisfaction score in the control group after 6 months of follow-up (0.7, SD 19.8), there was a marked reduction in EsDQOL satisfaction score in the intervention group (-13.7, SD 23.1; t=-3.08; P=.02). According to the ECODI scale, knowledge about diabetes increased more in the intervention group (intervention: 0.3, SD 1.8 vs control: 1.5, SD 1.5; t=-3.33; P=.001). Although the medication adherence score worsened in the control group after 6 months, it significantly improved with the intervention (control: -8% vs intervention: 13.8%; χ=0.35; P=.01). Patients' health care experiences improved with the intervention but not with the control. CONCLUSIONS: The digital educational intervention was effective at improving glycemic control, body composition, adherence, and patient satisfaction compared with usual care in patients with T2DM. The implementation of digital tools and social media could highly improve the multidisciplinary approach to the management of this population. TRIAL REGISTRATION: ClinicalTrials.gov NCT06850129; https://clinicaltrials.gov/study/NCT06850129.
背景:2型糖尿病(T2DM)患者的治疗依从性和代谢控制仍然具有挑战性。使用新技术,如远程医疗、数字化系统和社交网络,可能会改善自我管理和疾病控制。 目的:我们评估了针对T2DM患者的数字教育干预的效果,以糖化血红蛋白(HbA)和身体成分的变化来表示,并使用经过验证的对医护人员满意度问卷(慢性病患者体验评估工具)、糖尿病知识量表(ECODI)以及随访6个月期间的治疗依从性问卷(Morisky-Green-Levine药物评估问卷)来评估反应情况。 方法:这项多中心、随机、前瞻性研究纳入了代谢控制不佳且开始使用胰高血糖素样肽-1受体激动剂治疗的成年T2DM患者。患者被随机分为数字干预组或常规治疗组。干预组通过社交网络和数字工具接受关于健康生活方式改变的结构化教育项目。由一名“数字教练”提供每周一次的按需建议和个性化支持。收集基线和随访时的人口统计学、临床参数、依从性和生活质量数据。 结果:我们纳入了85名患者(对照组:n = 41;干预组:n = 44)。两组在人口统计学、体格检查、胰岛素和生化参数方面相匹配。我们观察到两组患者的体重(干预组:-8.7,标准差6.1 kg,对照组:-4.9,标准差5.0 kg;t = -3.13;P = 0.002)、体重指数(干预组:-3.0,标准差2.1 kg/m²,对照组:-1.8,标准差1.8 kg/m²;t = -2.82;P = 0.006)和去脂体重均有所下降,但干预组下降幅度更大。干预组的空腹血糖(干预组:122.6,标准差81.5 mg/dL,对照组:70.5,标准差72.9 mg/dL;t = 3.10;P = 0.004)和HbA(干预组:3.7%,标准差1.9%,对照组:2.6%,标准差2.1%;t = 2.54;P = 0.006)下降幅度更大。尽管随访6个月后对照组的西班牙文版糖尿病生活质量问卷(EsDQOL)满意度得分无显著变化(0.7,标准差19.8),但干预组的EsDQOL满意度得分显著降低(-13.7,标准差23.1;t = -3.08;P = 0.02)。根据ECODI量表,干预组患者对糖尿病的知识增加更多(干预组:0.3,标准差1.8,对照组:1.5,标准差1.5;t = -3.33;P = 0.001)。尽管对照组在6个月后的药物依从性得分变差,但干预组使其显著改善(对照组:-8%,干预组:13.8%;χ² = 0.35;P = 0.01)。干预改善了患者的医疗体验,而对照组则未改善。 结论:与T2DM患者的常规治疗相比,数字教育干预在改善血糖控制、身体成分、依从性和患者满意度方面是有效的。数字工具和社交媒体的应用可以极大地改善对这一人群的多学科管理方法。 试验注册:ClinicalTrials.gov NCT06850129;https://clinicaltrials.gov/study/NCT06850129
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