Telemed J E Health - Use of telemedicine to improve glycemic management in a skilled nursing facility: a pilot study.

Tópicos

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Resumo

The objective of this study was to evaluate the feasibility of using telemedicine to improve glycemic control (reduce episodes of hypoglycemia and severe hyperglycemia) for residents with diabetes in a skilled nursing facility. This randomized pilot study enrolled residents with diabetes (n=23; mean age, 83 years; 91% insulin-treated) and compared usual care (control; n=11) with usual care plus weekly/biweekly teleconsultations with an endocrinologist (n=12) for up to 6 months. A nurse and dietitian from the skilled nursing facility were at all televisits. Residents who were able and willing attended the televisits. Family members were also invited and occasionally were present. The endocrinologist reviewed glucose levels from point-of-care glucose meter downloads, dietary intake, medications, and medical status and recommended changes in glycemic therapy as needed. Measurements included glucose levels from point-of-care glucose meter downloads, hemoglobin A1c (A1c) levels, and a nurse satisfaction survey. Results showed that 7 of 10 insulin-treated intervention subjects had basal doses reduced (18-69%) compared with 2 of 11 control subjects (reduced 10% and 25%, respectively). There was a decrease in percentage of intervention participants with episodes of hypoglycemia (<80mg/dL) over the previous month from baseline (42%) to end of study (22%) versus a rise in the control group (from 36% to 45%) and less hyperglycemia (>400mg/dL) (intervention, from 33% to 22%; control, from 22% to 55%). There were no end-of-study A1c values >8.0% in the intervention group versus 44% in controls. Nursing staff at the skilled nursing facility expressed high satisfaction. Results suggest that telemedicine diabetes consultations to skilled nursing facilities can improve glycemic management.

Resumo Limpo

object studi evalu feasibl use telemedicin improv glycem control reduc episod hypoglycemia sever hyperglycemia resid diabet skill nurs facil random pilot studi enrol resid diabet n mean age year insulintr compar usual care control n usual care plus weeklybiweek teleconsult endocrinologist n month nurs dietitian skill nurs facil televisit resid abl will attend televisit famili member also invit occasion present endocrinologist review glucos level pointofcar glucos meter download dietari intak medic medic status recommend chang glycem therapi need measur includ glucos level pointofcar glucos meter download hemoglobin ac ac level nurs satisfact survey result show insulintr intervent subject basal dose reduc compar control subject reduc respect decreas percentag intervent particip episod hypoglycemia mgdl previous month baselin end studi versus rise control group less hyperglycemia mgdl intervent control endofstudi ac valu intervent group versus control nurs staff skill nurs facil express high satisfact result suggest telemedicin diabet consult skill nurs facil can improv glycem manag

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