在偏鄉衛生所使用手機應用程式及雲端管理輔助糖尿病照護

Using a Mobile Application and Cloud Management for Diabetes Care in a Rural Public Health Center

目的：我國的糖尿病照護品質有待改善，而偏鄉醫療資源相對缺乏，照護更加不足。目前智慧型手機十分普及，本研究探討在偏鄉衛生所使用手機應用程式(app)及雲端管理輔助糖尿病照護之效果。 方法：門診糖尿病病人在家自我監測血糖，將數據輸入 app，醫師於雲端平台依數據給予回饋；未使用 app 的病人定期至衛生所使用傳輸線將數據上傳平台。病人定期檢查糖化血色素(HbA1c)，完成6個月追蹤。本研究收集2016年9月1日至2018年8月31日期間衛生所門診第二型糖尿病病人的病歷及平台紀錄，比較使用 app 及未使用 app 病人的差異，採用無母數統計分析。 結果：共18位病人完成追蹤，其中8位使用 app，10位未使用 app。2組在追蹤6個月後，糖化血色素均降低、4-6個月比1-3個月的數據上傳筆數均減少(p<0.05)。app 組比非 app 組年齡較低、教育程度較高、糖尿病罹病時間較短、6個月糖化血色素降低量較多(p<0.05)。 結論：在偏鄉衛生所使用 app 及雲端管理輔助糖尿病照護可能有助於降低糖化血色素，但須進一步探討長期的效果以及如何應用到高齡病人。

 

Purpose: The quality of diabetes care has been unsatisfactory overall in Taiwan and particularly substandard in rural areas where medical resources are relatively scarce. In response to the immense popularity of smart phones, the study aimed to assess the effectiveness of utilizing a mobile application (app) and cloud management for diabetes care in a rural public health center. Methods: Outpatients with diabetes monitored their blood glucose at home and input the data into the app to help their doctors give feedback on a cloud platform. Patients who did not use the app were suggested to upload the data to the platform using the smart cable at the public health center. Patients were regularly examined for glycated hemoglobin (HbA1c) for a period of 6 months. Medical records and platform data of the outpatients with type 2 diabetes were collected from September 1, 2016 to August 31, 2018. Nonparametric statistics were used to compare the differences between patients using app and no-app. Results: 18 patients completed the 6-month follow-up, with 8 using the app and 10 not. After the 6-month follow-up, drop in HbA1c was observed in both the app and no-app groups, and the number of data upload decreased from the first 3 months to the later three (p<0.05). Compared to their counterparts in the no-app group, patients in the app group were younger, with a higher level of education, a shorter duration of diabetes, and a greater improvement in HbA1c at the 6th month (p<0.05). Conclusion: Using a mobile app and cloud management for diabetes care in a rural public health center may help reduce HbA1c, but further studies are needed to investigate the long term effectiveness of this approach and how to apply it to the elderly.