Kristoffersen Sofie Frigaard, Christensen Jeanette Reffstrup, Jeremiassen Louise Munk Ramo, Kylkjær Lea Bolette, Christensen Nanna Reffstrup, Jørgensen Sally Wullf, Kristensen Jette Kolding, Wehberg Sonja, Raymond Ilan Esra, Jarbøl Dorte E, Nielsen Jesper Bo, Søndergaard Jens, Olsen Michael Hecht, Nielsen Jens Steen, Brandt Carl J
Steno Diabetes Center Odense, Odense University Hospital, 5000 Odense, Denmark.
Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark.
Nutrients. 2025 Jul 30;17(15):2494. doi: 10.3390/nu17152494.
: Despite significant advancements in diabetes care, many individuals with type 2 diabetes (T2D) do not receive optimal care and treatment. Digital interventions promoting behavioral changes have shown promising long-term results in supporting healthier lifestyles but are not implemented in most healthcare offerings, maybe due to lack of general practice support and collaboration. This study evaluates the efficacy of the Digital, Individualized, and Collaborative Treatment of T2D in General Practice Based on Decision Aid (DICTA), a randomized controlled trial integrating a patient-centered smartphone application for lifestyle support in conjunction with a clinical decision support (CDS) tool to assist general practitioners (GPs) in optimizing antidiabetic treatment. : The present randomized controlled trial aims to recruit 400 individuals with T2D from approximately 70 GP clinics (GPCs) in Denmark. The GPCs will be cluster-randomized in a 2:3 ratio to intervention or control groups. The intervention group will receive one year of individualized eHealth lifestyle coaching via a smartphone application, guided by patient-reported outcomes (PROs). Alongside this, the GPCs will have access to the CDS tool to optimize pharmacological decision-making through electronic health records. The control group will receive usual care for one year, followed by the same intervention in the second year. : The primary outcome is the one-year change in estimated ten-year cardiovascular risk, assessed by SCORE2-Diabetes calculated from age, smoking status, systolic blood pressure, total and high-density lipoprotein cholesterol, age at diabetes diagnosis, HbA1c, and eGFR. : If effective, DICTA could offer a scalable, digital-first approach for improving T2D management in primary care by combining patient-centered lifestyle coaching with real-time pharmacological clinical decision support.
尽管糖尿病护理取得了重大进展，但许多2型糖尿病（T2D）患者并未得到最佳护理和治疗。促进行为改变的数字干预措施在支持更健康的生活方式方面显示出了有前景的长期效果，但在大多数医疗服务中并未得到应用，这可能是由于缺乏全科医生的支持与协作。本研究评估了基于决策辅助工具的全科医疗中2型糖尿病数字、个性化和协作治疗（DICTA）的疗效，这是一项随机对照试验，将以患者为中心的智能手机应用程序用于生活方式支持，同时结合临床决策支持（CDS）工具，以协助全科医生（GPs）优化抗糖尿病治疗。
本随机对照试验旨在从丹麦约70家全科诊所（GPCs）招募400名2型糖尿病患者。GPCs将按2:3的比例整群随机分为干预组或对照组。干预组将通过智能手机应用程序接受为期一年的个性化电子健康生活方式指导，并以患者报告的结果（PROs）为指导。与此同时，GPCs将能够使用CDS工具，通过电子健康记录优化药物治疗决策。对照组将接受一年的常规护理，第二年接受相同的干预。
主要结局是通过SCORE2-Diabetes评估的估计十年心血管风险的一年变化，该评估基于年龄、吸烟状况、收缩压、总胆固醇和高密度脂蛋白胆固醇、糖尿病诊断年龄、糖化血红蛋白（HbA1c）和估算肾小球滤过率（eGFR）计算得出。
如果有效，DICTA可以通过将以患者为中心的生活方式指导与实时药物临床决策支持相结合，为改善初级保健中的2型糖尿病管理提供一种可扩展的、以数字为先的方法。
