Diabetes Metab J.  2023 Sep;47(5):693-702. 10.4093/dmj.2022.0170.

Clinical Effects of a Home Care Pilot Program for Patients with Type 1 Diabetes Mellitus: A Retrospective Cohort Study

• Lee S
• Kim K
• Kim JE
• Hyun Y
• Lee M
• Hahm MI
• Lee SG
• Kang ES

• KMID: 2546127
• DOI: http://doi.org/10.4093/dmj.2022.0170

Abstract

Background
Given the importance of continuous self-care for people with type 1 diabetes mellitus (T1DM), the Ministry of Health and Welfare of Korea launched a pilot program for chronic disease management. Herein, we applied a home care pilot program to people with T1DM to investigate its effects.
Methods
This retrospective cohort study was conducted at a single tertiary hospital (January 2019 to October 2021). A multidisciplinary team comprising doctors, nurses, and clinical nutritionists provided specialized education and periodically assessed patients’ health status through phone calls or text messages. A linear mixed model adjusting for age, sex, and body mass index was used to analyze the glycemic control changes before and after implementing the program between the intervention and control groups.
Results
Among 408 people with T1DM, 196 were enrolled in the intervention group and 212 in the control group. The reduction in glycosylated hemoglobin (HbA1c) after the program was significantly greater in the intervention group than in the control group (estimated marginal mean, –0.57% vs. –0.23%, P=0.008); the same trend was confirmed for glycoalbumin (GA) (–3.2% vs. –0.39%, P<0.001). More patients achieved the target values of HbA1c (<7.0%) and GA (<20%) in the intervention group than in the control group at the 9-month follow-up (34.5% vs. 19.6% and 46.7% vs. 28.0%, respectively).
Conclusion
The home care program for T1DM was clinically effective in improving glycemic control and may provide an efficient care option for people with T1DM, and positive outcomes are expected to expand the program to include more patients.

Keyword

Diabetes mellitus, type 1; Home care services; Remote consultation

Figure

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  Fig. 1. Proportion of patients who achieved the target range. (A) Percentage of the population with a glycosylated hemoglobin level <7%. (B) Percentage of the population with a glycoalbumin level <20%. (C) Percentage of the population with an fasting blood glucose level <100 mg/dL. aP<0.05, bP<0.001.

• 

  Fig. 2. Clinical outcome trend from baseline to follow-ups at 3, 6, and 9 months. (A) Glycosylated hemoglobin (HbA1c) level over time (mean±standard deviation [SD]). (B) Glycoalbumin (GA) level over time (mean±SD). (C) Fasting blood glucose (FBG) level over time (mean±SD). (D) GA/HbA1c ratio over time (median±SD).

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