Enhancing self-management of T2DM with an Automated Reminder and Feedback System

通过自动提醒和反馈系统增强 T2DM 的自我管理

• 批准号: 7665494
• 负责人: EDITH A. BURNS
• 金额: $ 39.68万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-01 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7665494
• 关键词: Enhancing; self; management; T2DM; Automated

DESCRIPTION (PROVIDED BY APPLICANT): Randomized trials have shown that self-monitoring of blood glucose (SMBG) improves glycemic control in T2DM, but is most effective combined with feedback on what SMBG levels mean. We have developed an Automated Self-Management Monitor (ASMM) that prompts patients to perform SMBG and take medication, as well as having the capability to provide user-friendly feedback about the results obtained from SMBG. A feasibility trial was conducted in a small population of older adults and those using the ASMM increased SMBG frequency and improved A1c during a 3-month period. This grant proposes to rigorously test the ASMM, expanding the quality and type of feedback provided. This may be particularly effective in changing behavior because it is timely, regular, and delivered at home, where the bulk of self-management must occur. Objectives: Our primary objective is to demonstrate that the ASMM supports improvements in self management behaviors and glycemic control. Our specific aims include: 1) To demonstrate that use of the ASMM improves glycemic control in T2DM over 12 months. 2) To determine whether use of the ASMM is associated with sustained improvement in glycemic control over an additional 12 months of follow up. 3) To determine whether self-management behaviors are improved when using the ASMM. Methods: 200 community-dwelling adults with poorly controlled T2DM (A1c >8%) will be recruited from low-income housing sites in Milwaukee, and through primary care clinics affiliated with MCW. Participants will be randomized to a usual care control group (UC) or to the ASMM intervention group. The ASMM will be installed 3 months after enrollment, and will provide audio reminders to perform SMBG and take medications, and feedback regarding whether individual readings are within target ranges. The system will also provide feedback about the participants' trends in glycemic control for readings taken at that time of day (e.g., when a fasting blood sugar is checked, the system will relate the trend in fasting glucose levels for the prior two weeks, and whether the current reading will keep the trend stable, decreasing or increasing). The ASMM will remain with participants for 12 months. We will collect data on patient characteristics, glycemic control, SMBG patterns and results, medication dosing, diet, and physical activity at home visits conducted at baseline, 3 months (when participants will be trained in use of the ASMM), 9 months and 15 months. We will use change in A1c as the primary outcome. Secondary outcomes include changes in self-management behaviors. We will also examine whether certain patient characteristics modify the impact of the ASMM on these outcomes.

描述（由申请人提供）：随机试验表明，血糖（SMBG）的自我监控改善了T2DM的血糖控制，但最有效地结合了SMBG水平的反馈。我们已经开发了一个自动化的自我管理监视器（ASMM），该显示器促使患者执行SMBG并服用药物，并具有有关从SMBG获得的结果提供用户友好的反馈。在少数老年人中进行了可行性试验，使用ASMM的人增加了SMBG频率，并在3个月的时间内提高了A1C。该赠款建议严格测试ASMM，扩大提供的反馈的质量和类型。这可能在改变行为方面特别有效，因为它是及时的，规则的，并且在家里交付，必须发生大部分自我管理。目标：我们的主要目标是证明ASMM支持改善自我管理行为和血糖控制。我们的具体目的包括：1）证明使用ASMM可以在12个月内改善T2DM的血糖控制。 2）确定在另外12个月的随访中，ASMM的使用是否与血糖控制的持续改善有关。 3）确定使用ASMM时的自我管理行为是否得到改善。方法：200名居民控制不良的T2DM（A1C> 8％）的成年人将从密尔沃基的低收入住房站点招募，并通过MCW隶属的初级保健诊所。参与者将被随机分为通常的护理对照组（UC）或ASMM干预组。 ASMM将在入学后3个月安装，并将提供音频提醒，以执行SMBG并服用药物，以及有关单个读数是否在目标范围内的反馈。该系统还将提供有关参与者在一天中的读数中的血糖控制趋势的反馈（例如，当检查空腹血糖时，系统将在前两周内将禁食葡萄糖水平的趋势联系起来，以及当前的读数是否会保持趋势稳定，减少或增加）。 ASMM将与参与者在一起12个月。我们将收集有关患者特征，血糖控制，SMBG模式和结果，药物给药，饮食和体育锻炼的数据，该数据在基线时进行了3个月（何时将接受ASMM使用ASMM），9个月零15个月的培训。我们将使用A1C中的更改作为主要结果。次要结果包括自我管理行为的变化。我们还将检查某些患者特征是否会改变ASMM对这些结果的影响。