192-OR: 内分泌科医生和家庭医生之间的视频会议对 2 型糖尿病患者推荐药物治疗水平的影响--实用性 RCT

IF 6.2 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes Pub Date : 2024-07-19 DOI:10.2337/db24-192-or
THIM PRÆTORIUS, ANNE SOFIE B. LUNDBERG, ESKILD K. FREDSLUND, NIKLAS B. ROSSEN, SØREN GREGERSEN, ANDERS PRIOR, ESBEN SØNDERGAARD, SOREN T. KNUDSEN, ANNELLI SANDBÆK
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Family practices were randomized 1:1 to usual phone-based hospital support or a sequence of four video conferences (45 min) with an endocrinologist over 12 months. Co-primary outcomes at months 12-15 were the proportion of persons with T2D and 1) ischemic heart disease and/or stroke receiving GLP1-RA and/or SGLT2 inhibitor; 2) micro/macro-albuminuria receiving ACE/AT2; and 3) LDL >2.5 mmol/L receiving statins. Secondary outcomes were the proportion below treatment cut-offs e.g.: HbA1c <58 mmol/L; systolic BP <140 mm Hg. Data were collected from electronic records and analyzed using t-tests. Results: Fourteen family practices were randomized to the intervention and 11 to usual support: no significant differences in practice characteristics. 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引用次数: 0

摘要

导言和目标:为了缩小 2 型糖尿病(T2D)的治疗差距,2023 年美国国家临床护理委员会呼吁测试虚拟协作模式。我们研究了内分泌专家和家庭医生之间的视频会议对家庭医生接诊的 T2D 患者推荐药物治疗水平的影响。研究方法对丹麦奥胡斯市的 25 家家庭诊所(平均患者人数:4245 人)(邀请了所有 100 家诊所后确定)和一家内分泌科进行双臂、务实的 RCT 研究。家庭诊所以 1:1 的比例被随机分配到通常的电话医院支持或在 12 个月内与内分泌专家进行四次视频会议(45 分钟)。第12-15个月的共同主要结果是患有T2D和1)缺血性心脏病和/或中风的患者接受GLP1-RA和/或SGLT2抑制剂治疗的比例;2)微量/宏观白蛋白尿患者接受ACE/AT2治疗的比例;以及3)低密度脂蛋白>2.5 mmol/L患者接受他汀类药物治疗的比例。次要结果是低于治疗临界值的比例,如HbA1c &;lt;58 mmol/L;收缩压 <140 mm Hg。数据通过电子记录收集,并使用 t 检验进行分析。结果:14个家庭诊所被随机纳入干预方案,11个被纳入常规支持方案:诊所特征无显著差异。试验结束时,在干预组和对照组中:分别有 65.2% 和 47.6% 的 T2D 和缺血性心脏病和/或中风患者接受了 GLP1-RA 和/或 SGLT2 抑制剂治疗(CI 4.6;30.7%);分别有 94.7% 和 95.8% 的 T2D 和缺血性心脏病和/或中风患者接受了 GLP1-RA 和/或 SGLT2 抑制剂治疗。7%和95.8%的T2D和微/宏观白蛋白尿患者接受了ACE/AT2治疗(CI -2.8;0.6%);90.1%和90.1%的T2D和LDL>2.5 mmol/L患者接受了他汀类药物治疗(CI -3.5;3.6%)。我们在次要结果中未发现明显差异。结论内分泌科医生和家庭医生之间的视频会议可以通过加快知识传播和合作,缩小T2D和心血管疾病患者在药物治疗方面的差距。披露 T. Prætorius:研究支持;诺和诺德基金会。A.B. Lundberg:其他关系;诺和诺德基金会。E.K. Fredslund:顾问;丹麦诺华公司。N.B. Rossen:无。S. Gregersen:无。A. Prior:无。E. Søndergaard: None.S.T. Knudsen:其他关系;勃林格殷格翰公司、赛诺菲公司、Mundipharma公司、诺和诺德公司、默克夏普公司、多美公司、雅培公司、拜耳公司。研究支持;礼来公司。Speaker's Bureau; Eli Lilly and Company.A. Sandbæk:Boehringer-Ingelheim 董事会成员。丹麦中部大区质量和培训委员会 (1-30-72-404-21);诺和诺德基金会 (NNF17SA0031230-1)
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192-OR: Effect of Video Conferences between Endocrinologists and Family Doctors on Levels of Recommended Medication among Persons with Type 2 Diabetes—Pragmatic RCT
Introduction and objective: To close treatment gaps in type 2 diabetes (T2D), a 2023 US National Clinical Care Commission calls for testing models of virtual collaboration. We examined the effect of video conferences between endocrinologists and family doctors on levels of recommended medication among persons with T2D seen in family practice. Methods: Two arm, pragmatic RCT with 25 family practices (mean no. of patients: 4,245) from Aarhus Municipality, Denmark (identified after inviting all 100), and one endocrinology department. Family practices were randomized 1:1 to usual phone-based hospital support or a sequence of four video conferences (45 min) with an endocrinologist over 12 months. Co-primary outcomes at months 12-15 were the proportion of persons with T2D and 1) ischemic heart disease and/or stroke receiving GLP1-RA and/or SGLT2 inhibitor; 2) micro/macro-albuminuria receiving ACE/AT2; and 3) LDL >2.5 mmol/L receiving statins. Secondary outcomes were the proportion below treatment cut-offs e.g.: HbA1c <58 mmol/L; systolic BP <140 mm Hg. Data were collected from electronic records and analyzed using t-tests. Results: Fourteen family practices were randomized to the intervention and 11 to usual support: no significant differences in practice characteristics. At the trial end, in the intervention and control groups: 65.2% and 47.6% of persons with T2D and ischemic heart disease and/or stroke received GLP1-RA and/or SGLT2 inhibitor (CI 4.6;30.7%); 94.7% and 95.8% of persons with T2D and micro/macro-albuminuria received ACE/AT2 (CI -2.8;0.6%); and 90.1% and 90.1% of persons with T2D and LDL>2.5 mmol/L received statins (CI -3.5;3.6%). We found no significant differences in secondary outcomes. Conclusion: Video conferences between endocrinologists and family doctors can close gaps in medication treatment for persons with T2D and CVD by accelerating knowledge diffusion and collaboration. Disclosure T. Prætorius: Research Support; Novo Nordisk Foundation. A.B. Lundberg: Other Relationship; Novo Nordisk Foundation. E.K. Fredslund: Consultant; Novartis Denmark. N.B. Rossen: None. S. Gregersen: None. A. Prior: None. E. Søndergaard: None. S.T. Knudsen: Other Relationship; Boehringer-Ingelheim, Sanofi, Mundipharma, Novo Nordisk A/S, Merck Sharp & Dohme Corp., Abbott, Bayer Inc. Research Support; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. A. Sandbæk: Board Member; Boehringer-Ingelheim. Funding Quality and Training Committee of Central Denmark Region (1-30-72-404-21); Novo Nordisk Foundation (NNF17SA0031230-1)
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来源期刊
Diabetes
Diabetes 医学-内分泌学与代谢
CiteScore
12.50
自引率
2.60%
发文量
1968
审稿时长
1 months
期刊介绍: Diabetes is a scientific journal that publishes original research exploring the physiological and pathophysiological aspects of diabetes mellitus. We encourage submissions of manuscripts pertaining to laboratory, animal, or human research, covering a wide range of topics. Our primary focus is on investigative reports investigating various aspects such as the development and progression of diabetes, along with its associated complications. We also welcome studies delving into normal and pathological pancreatic islet function and intermediary metabolism, as well as exploring the mechanisms of drug and hormone action from a pharmacological perspective. Additionally, we encourage submissions that delve into the biochemical and molecular aspects of both normal and abnormal biological processes. However, it is important to note that we do not publish studies relating to diabetes education or the application of accepted therapeutic and diagnostic approaches to patients with diabetes mellitus. Our aim is to provide a platform for research that contributes to advancing our understanding of the underlying mechanisms and processes of diabetes.
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