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目的:探讨实时互动式远程糖尿病管理系统,应用于门诊2型糖尿病起始胰岛素治疗患者的效果。方法:入选口服药物控制不佳,需要起始胰岛素治疗的2型糖尿病门诊就诊患者60例,随机分配至远程管理组和常规门诊组,每组30例。2组均接受糖尿病专科护士胰岛素注射培训。远程组患者配备家用机及血糖仪等外围设备,实现家中检测数据的上传、各项检测实施的提醒、相关教育信息的转达、以及实现与远程管理者多功能互动。糖尿病专科护士在后台操作平台通过网络实时监控远程患者的检测指标,及时进行重点指标的干预管理。常规门诊组自行在家中监测血糖。2组均根据需要门诊随诊,研究进行3个月。比较2组在干预后糖代谢指标和自我管理技能的变化。结果:2组年龄、糖尿病病程、各项糖代谢指标以及自我管理行为量表得分在基线时,差异均无统计学(P>0.05)。在3个月后2组的空腹血糖、餐后2h血糖及HbA1c,均较基线时明显下降(P<0.001);并且远程组比常规组下降更为明显(P<0.001或P<0.05)。远程组HbA1c<7%达标率高于常规组(P<0.05)。远程组低血糖事件例次数明显少于常规组(32次vs.58次,P<0.01)。3个月后再次测评自我管理行为量表,2组6个分量表得分均较基线时明显提高(P<0.001或P<0.01);除用药管理行为外,其余5个量表远程组比常规组提高更为明显(P<0.001或P<0.05)。结论:短期实时互动式远程糖尿病管理模式较常规门诊管理可显著改善起始胰岛素治疗2型糖尿病患者糖代谢达标率,并提高患者自我管理技能水平。
Objective: To explore the effect of real-time interactive remote diabetes management system in outpatients with initial type 2 diabetes mellitus. Methods: Sixty patients admitted to the Type 2 Diabetes Outpatient Department who underwent poor insulin control and started insulin therapy were randomly assigned to a remote management group and a routine out-patient group, 30 patients in each group. Both groups received insulin injection training for diabetic nurses. Patients in the remote group are equipped with peripheral devices such as a home machine and a blood glucose meter to upload home test data, remind detection of various tests, transfer of relevant educational information, and achieve multi-functional interaction with remote managers. Diabetes specialist nurses in the background operating platform real-time monitoring of remote detection of patients through the network indicators, timely intervention in the management of key indicators. Routine outpatient groups monitor their own blood glucose at home. Both groups were followed up according to the needs of the clinic, the study for 3 months. The changes of glucose metabolism index and self-management skills in two groups were compared. Results: There was no significant difference between the two groups in age, duration of diabetes, glucose metabolism index and self-management behavior scale at baseline. After 3 months, the fasting blood glucose, 2h postprandial blood glucose and HbA1c in two groups were significantly lower than those in baseline (P <0.001); and the remote group was more obvious than the conventional group (P <0.001 or P <0.05). Remote group HbA1c <7% compliance rate was higher than the conventional group (P <0.05). Long-distance hypoglycemia cases were significantly fewer cases than the conventional group (32 vs. 58 times, P <0.01). Three months later, the self-management behavior scale was again evaluated. The scores of six subscales in two groups were all significantly higher than those at baseline (P <0.001 or P <0.01). Except medication administration, Group increased more significantly (P <0.001 or P <0.05). Conclusion: Short-term real-time interactive remote diabetes management mode can significantly improve the rate of glycometabolic compliance in patients with type 2 diabetes and improve self-management skills in patients undergoing initial insulin treatment as compared with routine outpatient management.