Construction And Application Of Evidence-based Remote Intervention Program For Pre-diabetic Population

ObjectiveTo provide a scientific,standardized,and feasible pre-diabetes population management model for primary prevention of diabetes,we summarize the data of pre-diabetes management based on evidence-based health care model of JBI.Then,we used Ding-Talk APP to develop a remote intervention program,implement the intervention program and evaluate the effect.MethodThis study was divided into two parts.Part Ⅰ: According to the 6S evidence search pyramid principle,we comprehensively searched the guidelines,evidence summary,systematic review,and expert consensus on pre-diabetes intervention,and evaluated and summarized literature evidence.Then,we used stakeholder meetings and interviews to evaluate the FAME structure of the evidence,screened out the best evidence suitable for clinical practice,and wrote a draft of a pre-diabetes population intervention program.Finally,we demonstrated the feasibility of the draft and Ding-Talk APP as a remote intervention through expert argumentation.Part Ⅱ: A total of 68 patients with pre-diabetes diagnosed in the health management center of a tertiary hospital in Qingdao from May to July 2021 were selected and randomly divided into the control group and the intervention group.The control group received the regular intervention,while the intervention group received the regular intervention + remote intervention.Body mass index(BMI),fasting blood glucose,2-hour postprandial blood glucose,and glycosylated hemoglobin were measured before and 6-month after the intervention.Subjects completed the pre-diabetes self-management scale and pre-diabetes disease knowledge questionnaire.Chi-square test was used to compare the general data of the two groups of patients,and rank sum test was used to compare the glucose metabolism-related indicators,overweight rate,self-management ability,and disease knowledge level between and with in the two groups before and after intervention,the test level was ɑ= 0.05,P<0.05 meant that the difference is statistically significant.ResultThrough literature retrieval and literature quality evaluation,nine papers were finally included,including three guidelines,one evidence summary,two systematic reviews,and three expert consensuses.Furtherly,we obtained 40 pieces of the best evidence from eight aspects,including assessment,health education,lifestyle intervention,monitoring and follow-up,drug intervention,traditional Chinese medicine exercise,psychological intervention,and the composition of intervention personnel.After evaluating the feasibility,suitability,clinical significance,and effectiveness,19 pieces of the best evidence suitable for clinical practice were screened and adjusted.Finally,we wrote a clinical remote intervention program for pre-diabetes population and passed experts demonstration of the program and Ding-Talk APP function.The results showed that,before the intervention,there was no significant difference between the intervention group and the control group,after 6-month of intervention:(1)the 2-hour postprandial blood glucose(Z=-1.982,P < 0.05)and glycosylated hemoglobin(Z=-2.318,P < 0.05)in the intervention group were significantly lower than those in the control.However,there was no significant difference in fasting blood glucose between the two groups(P>0.05).(2)Compared with the control group,the overweight rate of the intervention group decreased significantly after 6-month of intervention(P<0.05).(3)The self-management ability of the intervention group was significantly stronger than that of the control group(Z=-2.425,P<0.05).(4)The score of pre-diabetes knowledge in the intervention group was significantly higher than that of the control group(Z=-5.167,P<0.05).Conclusion1.Using the Ding-Talk APP to implement a remote intervention program for the pre-diabetes population is appropriate,feasible,and scientific.2.The remote intervention program for the pre-diabetes population implemented by Ding-Talk APP contributes to the control of blood glucose and weight of patients.Besides,it improves their self-management ability and mastery of diabetes-related knowledge.