@Article{info:doi/10.2196/60023,
author="Koo, Dae-Jeong
and Moon, Sun-Joon
and Moon, Suhyeon
and Park, Se Eun
and Rhee, Eun-Jung
and Lee, Won-Young
and Park, Cheol-Young",
title="Long-Term Glycemic Control Improvement After the Home and Self-Care Program for Patients With Type 1 Diabetes: Real-World--Based Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="11",
volume="26",
pages="e60023",
keywords="type 1 diabetes; structured education; home health care; glycated hemoglobin; continuous glucose monitoring; mobile phone",
abstract="Background: The prevalence of type 1 diabetes (T1D) is increasing worldwide, with a much higher proportion of adult patients. However, achieving stable glycemic control is difficult in these patients. Objective: After periodic implementation of structured education for patients with T1D through the Home and Self-Care Program, a pilot home health care project promoted by the Korean government, we evaluated the program's effects on glycemic control. Methods: This study was conducted from April 2020 to March 2023. We analyzed 119 participants with T1D aged >15 years. Nursing and nutrition education were provided separately up to 4 times per year, with physician consultation up to 6 times per year. A distinguishing feature of this study compared with previous ones was the provision of remote support using a general-purpose smartphone communication app offered up to 12 times annually on an as-needed basis to enhance the continuity of in-person education effects. Patients were followed up on at average intervals of 3 months for up to 24 months. The primary end point was the mean difference in glycated hemoglobin (HbA1c) at each follow-up visit from baseline. For continuous glucose monitoring (CGM) users, CGM metrics were also evaluated. Results: The mean HbA1c level of study participants was 8.6{\%} at baseline (mean duration of T1D 10.02, SD 16.10 y). The HbA1c level reduction in participants who received at least 1 structured educational session went from 1.63{\%} (SD 2.03{\%}; P<.001; adjustment model=1.69{\%}, 95{\%} CI 1.24{\%}-2.13{\%} at the first follow-up visit) to 1.23{\%} (SD 1.31{\%}; P=.01; adjustment model=1.28{\%}, 95{\%} CI 0.78{\%}-1.79{\%} at the eighth follow-up visit). In the adjustment model, the actual mean HbA1c values were maintained between a minimum of 7.33{\%} (95{\%} CI 7.20{\%}-7.46{\%} at the first follow-up visit) and a maximum of 7.62{\%} (95{\%} CI 7.41{\%}-7.82{\%} at the sixth follow-up visit). Among CGM users, after at least 1 session, the mean time in the target range was maintained between 61.59{\%} (adjusted model, 95{\%} CI 58.14{\%}-65.03{\%} at the second follow-up visit) and 54.7{\%} (95{\%} CI 50.92{\%}-58.48{\%} at the eighth follow-up visit), consistently staying above 54.7{\%} (corresponding to an HbA1c level of <7.6{\%}). The mean time below the target range (TBR) also gradually improved to the recommended range (≤4{\%} for TBR of <70 mg/dL and ≤1{\%} for TBR of <54 mg/dL). Conclusions: The Home and Self-Care Program protocol for glycemic control in patients with T1D is effective, producing significant improvement immediately and long-term maintenance effects, including on CGM indexes. ",
issn="1438-8871",
doi="10.2196/60023",
url="https://www.jmir.org/2024/1/e60023",
url="https://doi.org/10.2196/60023"
}