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Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation

BACKGROUND: Type II diabetes mellitus (T2DM) presents a major disease burden in the United States. Outpatient glycemic control among patients with T2DM remains difficult. Telemedicine shows great potential as an adjunct therapy to aid in glycemic control in real-world settings. OBJECTIVE: We aimed t...

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Autores principales: Peters, Robert Mattson, Lui, Matt, Patel, Kunjan, Tian, Lewis, Javaherian, Kavon, Sink, Eric, Xu, Ran, Xu, Zhuchen, Aung, Wint, Zhou, Li, Huynh, Justin, Polites, Gregory, Blanchard, Melvin, Som, Avik, Ross, Will, Bernal-Mizrachi, Carlos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6238836/
https://www.ncbi.nlm.nih.gov/pubmed/30291063
http://dx.doi.org/10.2196/diabetes.7910
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author Peters, Robert Mattson
Lui, Matt
Patel, Kunjan
Tian, Lewis
Javaherian, Kavon
Sink, Eric
Xu, Ran
Xu, Zhuchen
Aung, Wint
Zhou, Li
Huynh, Justin
Polites, Gregory
Blanchard, Melvin
Som, Avik
Ross, Will
Bernal-Mizrachi, Carlos
author_facet Peters, Robert Mattson
Lui, Matt
Patel, Kunjan
Tian, Lewis
Javaherian, Kavon
Sink, Eric
Xu, Ran
Xu, Zhuchen
Aung, Wint
Zhou, Li
Huynh, Justin
Polites, Gregory
Blanchard, Melvin
Som, Avik
Ross, Will
Bernal-Mizrachi, Carlos
author_sort Peters, Robert Mattson
collection PubMed
description BACKGROUND: Type II diabetes mellitus (T2DM) presents a major disease burden in the United States. Outpatient glycemic control among patients with T2DM remains difficult. Telemedicine shows great potential as an adjunct therapy to aid in glycemic control in real-world settings. OBJECTIVE: We aimed to explore the effectiveness of EpxDiabetes, a novel digital health intervention, in improving hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) among patients with uncontrolled diabetes. METHODS: We recruited 396 patients from a community clinic in St. Louis, Missouri, from a database of patients diagnosed with T2DM and with a most recent HbA1c >7% as part of a quality improvement project. An automated call or text-messaging system was used to monitor patient-reported FBG. If determined to be elevated, care managers were notified by email, text, or electronic medical record alert. Participants self-reported their FBG data by replying to EpxDiabetes automated phone calls or text messages. Data were subsequently analyzed, triaged, and shared with providers to enable appropriate follow-up and care plan adjustments. Absolute HbA1c reduction, patient engagement, and absolute patient-reported FBG reduction were examined at approximately 6 months post implementation. RESULTS: EpxDiabetes had an average 95.6% patient response rate to messages at least once per month and an average 71.1% response rate to messages at least once per week. Subsequent HbA1c drop with EpxDiabetes use over 4 months was -1.15% (95% CI -1.58 to -0.71) for patients with HbA1c >8% at baseline compared to the change in HbA1c over 4 months prior to the implementation of EpxDiabetes of only -0.005 points (95% CI -0.28 to 0.27), P=.0018. CONCLUSIONS: EpxDiabetes may help reduce HbA1c in patients with high HbA1c baselines (>8%). The intervention demonstrates high patient engagement sustainable for at least 6 months.
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spelling pubmed-62388362018-12-27 Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation Peters, Robert Mattson Lui, Matt Patel, Kunjan Tian, Lewis Javaherian, Kavon Sink, Eric Xu, Ran Xu, Zhuchen Aung, Wint Zhou, Li Huynh, Justin Polites, Gregory Blanchard, Melvin Som, Avik Ross, Will Bernal-Mizrachi, Carlos JMIR Diabetes Original Paper BACKGROUND: Type II diabetes mellitus (T2DM) presents a major disease burden in the United States. Outpatient glycemic control among patients with T2DM remains difficult. Telemedicine shows great potential as an adjunct therapy to aid in glycemic control in real-world settings. OBJECTIVE: We aimed to explore the effectiveness of EpxDiabetes, a novel digital health intervention, in improving hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) among patients with uncontrolled diabetes. METHODS: We recruited 396 patients from a community clinic in St. Louis, Missouri, from a database of patients diagnosed with T2DM and with a most recent HbA1c >7% as part of a quality improvement project. An automated call or text-messaging system was used to monitor patient-reported FBG. If determined to be elevated, care managers were notified by email, text, or electronic medical record alert. Participants self-reported their FBG data by replying to EpxDiabetes automated phone calls or text messages. Data were subsequently analyzed, triaged, and shared with providers to enable appropriate follow-up and care plan adjustments. Absolute HbA1c reduction, patient engagement, and absolute patient-reported FBG reduction were examined at approximately 6 months post implementation. RESULTS: EpxDiabetes had an average 95.6% patient response rate to messages at least once per month and an average 71.1% response rate to messages at least once per week. Subsequent HbA1c drop with EpxDiabetes use over 4 months was -1.15% (95% CI -1.58 to -0.71) for patients with HbA1c >8% at baseline compared to the change in HbA1c over 4 months prior to the implementation of EpxDiabetes of only -0.005 points (95% CI -0.28 to 0.27), P=.0018. CONCLUSIONS: EpxDiabetes may help reduce HbA1c in patients with high HbA1c baselines (>8%). The intervention demonstrates high patient engagement sustainable for at least 6 months. JMIR Publications 2017-07-25 /pmc/articles/PMC6238836/ /pubmed/30291063 http://dx.doi.org/10.2196/diabetes.7910 Text en ©Robert Mattson Peters, Matt Lui, Kunjan Patel, Lewis Tian, Kavon Javaherian, Eric Sink, Ran Xu, Zhuchen Xu, Wint Aung, Li Zhou, Justin Huynh, Gregory Polites, Melvin Blanchard, Avik Som, Will Ross, Carlos Bernal-Mizrachi. Originally published in JMIR Diabetes (http://diabetes.jmir.org), 25.07.2017. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Diabetes, is properly cited. The complete bibliographic information, a link to the original publication on http://diabetes.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Peters, Robert Mattson
Lui, Matt
Patel, Kunjan
Tian, Lewis
Javaherian, Kavon
Sink, Eric
Xu, Ran
Xu, Zhuchen
Aung, Wint
Zhou, Li
Huynh, Justin
Polites, Gregory
Blanchard, Melvin
Som, Avik
Ross, Will
Bernal-Mizrachi, Carlos
Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation
title Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation
title_full Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation
title_fullStr Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation
title_full_unstemmed Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation
title_short Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation
title_sort improving glycemic control with a standardized text-message and phone-based intervention: a community implementation
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6238836/
https://www.ncbi.nlm.nih.gov/pubmed/30291063
http://dx.doi.org/10.2196/diabetes.7910
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