HbA1c ≧ 7.5%
糖尿病自己管理教育ゲーム + 公衆についての冊子
公衆についてのゲーム + 糖尿病自己管理教育の冊子
＊ HbA1cがIFCC mmol/molなので、HbA1c(NGSP)％に変換して紹介しています。
DSME game patients had significantly greater HbA1c reductions over 12 months than civics game patients (-8 mmol/mol [95% CI -10 to -7] and -5 mmol/mol [95% CI -7 to -3], respectively; P = 0.048). HbA1c reductions were greater among patients with baseline HbA1c >75 mmol/mol: -16 mmol/mol [95% CI -21 to -12] and -9 mmol/mol [95% CI -14 to -5] for DSME and civics game patients, respectively; P = 0.031.
PPR was generated for oral diabetes medications during the intervention and follow-up periods and was calculated by taking the total number of day’s supply that the patient received over the course of the study, including any fills that overlapped the beginning or end of the study period, divided by the time between the first fill date and the fill date of the first prescription outside of the study period. If the patient was on multiple diabetes drugs, PPRs were averaged across drugs taken in the same study period. Charlson comorbidity indices, Elixhauser comorbidity indices, and Diabetes Complications Severity Scale scores were calculated using ICD-9 coding algorithms (25–27).
注 PPR=pill possession ratio 薬の内服実施率
Clinical Data Sources
At enrollment and at 6 and 12 months after the launch of the game, patients were sent a home test kit and asked to return a fingerstick blood sample blotted on filter paper and urine specimen by mail. These specimens were assayed by a commercial laboratory for HbA1c (coefficient of variation: 3.0–3.9%), urine albumin, and urine creatinine (Home Access Inc.). Patient information was withheld from the outside laboratory through use of coded identifiers. In addition, patients completed two online questionnaires: an 8-item Diabetes Empowerment Scale (DES) Short Form (23) and 20-item Problem Areas in Diabetes (PAID) questionnaire (24), at baseline, 6 months, and 12 months. Patients were sent a $75 gift certificate at each of these time points. Additional clinical data were extracted from the VA Corporate Data Warehouse.
Although rewards were structured to take advantage of the demonstrated efficacy of group-based financial incentives (21), we also included individual-based awards to maintain engagement among participants on lower-performing teams. At the end of the game, all members of the two teams with the most points in each arm received a $100 gift certificate to an online store. In addition, the top 30% of individual patients on the remaining teams in each arm received a $100 gift certificate.
Kerfoot BP et al., Diabetes Care. 2017 Sep;40(9):1218-1225.