ADA2013：遠程醫療可改善患者生活方式

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生活方式改變往往因失去動力而失敗。遠程醫療和私人指導有支持生活方式改變和減肥的潛能。為了驗證在超重受試者，有和沒有遠程醫療指導與對照組相比對減肥的影響，來自西德糖尿病和健康中心的Stephan Martin教授及其團隊進行了一項研究，該研究發現遠程醫療適用于刺激超重個體進行生活方式改變。

該研究在一個職業健康保健場所，體重指數（BMI）＞27kg/m²的超重員工（180例）被隨機分為三組進行12周的試驗。遠程醫療（TM）和遠程醫療指導（TMC）組受試者獲得一個稱量器和一個自動計步器傳遞到個人在線門戶，可以同時被受試者和研究中心監控。TMC組每周接到一次研究中心的關懷電話，目的是討論測量數據，并確定目標協議。對照組依然接受日常保健。使用Wilcoxon符號秩和檢驗確定差異（基線vs 12周后）是否與0存在顯著差異，使用單因素方差分析（ANOVA）確定組內差異

該研究結果表明，93%的TMC受試者、90%的TM受試者和79%的對照組受試者完成12周的研究。基線參數沒有顯著差異。TMC組（-3.7±4.7kg,p＜0.0001）和TM組（-2.5±4.1kg,p＜0.0003）體重顯著下降，然而，在對照組，體重減少在臨界水平（-0.9±2.9kg,p=0.1）。與對照組相比，僅TMC組體重下降有統計學意義（p＜0.001）。在TMC組，BMI、腰圍、總膽固醇、甘油三酯、收縮壓和舒張壓顯著改善，而在TM組，僅甘油三酯和血壓有顯著改善。

該研究發現，遠程醫療適用于刺激超重個體進行生活方式改變，然而結合電話指導，出現體重減輕和心臟代謝危險因素減少。

Lifestyle changes often fail due to loss of motivation. Telemedicine and personal coaching have the potential to support lifestyle change and weight loss. Therefore the aim of our randomized controlled trial was to examine the effect of telemedicine with and without coaching in comparison to a control group on weight loss in overweight participants.

In an occupational health care setting overweight employees (n=180) with a body mass index (BMI) > 27 kg/m2 (45% men mean age 45 ±10 years) were randomized into a three arm 12-week trial. Participants in the telemedical (TM) and telemedical coaching (TMC) group got a weighing machine and a step counter with automatic transfer into a personalized online portal which could be monitored from both the participant and the study centre. The TMC group weekly got care calls from the study centre aiming to discuss measured data and to fix target agreements. The control group remained in routine care. Wilcoxon signed rank test was used to determine if differences (baseline vs. after 12 weeks) were significantly different from 0 and ANOVA test for determination of inter group differences.

93% of participants from the TMC 90% of the TM and 79% of the control group completed the 12-week study. Baseline parameters did not significantly differ. Participants in the TMC (-3.7 ± 4.7 kg p<0.0001) and in the TM group (-2.5 ± 4.1 kg; p=0.0003) significantly lost weight while in the control group the weight reduction (-0.9 ± 2.9 kg p=0.1) was marginal. Compared to the control group only weight loss in the TMC group was statistically significant (p<0.001). In the TMC group also BMI waist circumference total cholesterol triglycerides systolic and diastolic blood pressure significantly improved while in the TM group only significant improvements for triglycerides and blood pressure occurred.

Telemedicine is applicable to motivate overweight individuals for lifestyle changes whereas in combination with telephone coaching weight loss and reduction of cardiometabolic risk factors expand.

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編輯： 葛根    來源：丁香園