ADA2013：远程医疗可改善患者生活方式

生活方式改变往往因失去动力而失败。远程医疗和私人指导有支持生活方式改变和减肥的潜能。为了验证在超重受试者，有和没有远程医疗指导与对照组相比对减肥的影响，来自西德糖尿病和健康中心的Stephan Martin教授及其团队进行了一项研究，该研究发现远程医疗适用于刺激超重个体进行生活方式改变。

该研究在一个职业健康保健场所，体重指数（BMI）＞27kg/m²的超重员工（180例）被随机分为三组进行12周的试验。远程医疗（TM）和远程医疗指导（TMC）组受试者获得一个称量器和一个自动计步器传递到个人在线门户，可以同时被受试者和研究中心监控。TMC组每周接到一次研究中心的关怀电话，目的是讨论测量数据，并确定目标协议。对照组依然接受日常保健。使用Wilcoxon符号秩和检验确定差异（基线vs 12周后）是否与0存在显著差异，使用单因素方差分析（ANOVA）确定组内差异

该研究结果表明，93%的TMC受试者、90%的TM受试者和79%的对照组受试者完成12周的研究。基线参数没有显著差异。TMC组（-3.7±4.7kg,p＜0.0001）和TM组（-2.5±4.1kg,p＜0.0003）体重显著下降，然而，在对照组，体重减少在临界水平（-0.9±2.9kg,p=0.1）。与对照组相比，仅TMC组体重下降有统计学意义（p＜0.001）。在TMC组，BMI、腰围、总胆固醇、甘油三酯、收缩压和舒张压显著改善，而在TM组，仅甘油三酯和血压有显著改善。

该研究发现，远程医疗适用于刺激超重个体进行生活方式改变，然而结合电话指导，出现体重减轻和心脏代谢危险因素减少。

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.

编辑： 葛根    来源：丁香园