Patient Empowerment Using Electronic Telemonitoring With Telephone Support in the Transition to Insulin Therapy in Adults With Type 2 Diabetes: Observational, Pre-Post, Mixed Methods Study

Abstract

Background Initiation of insulin therapy for the management of type 2 diabetes can be an unwelcome and distressful development for patients. Current evidence suggests that telemonitoring can help improve glycemic control in type 2 diabetes and can support empowerment to self-manage diabetes. This telemonitoring intervention was underpinned by an empowerment approach. Objective This study aimed to evaluate the clinical effectiveness and feasibility and the patients’ and health care providers’ experiences of a 12-week telemonitoring intervention with telephone support for patients commencing insulin therapy. This paper focuses on the impact on patient empowerment. Methods An observational, pre-post, multimethod, and triangulation design was employed to study a 12-week automated electronic telemonitoring intervention with telephone support from a diabetes clinical nurse specialist (CNS). Forty patients were recruited from the clinic as they were about to commence insulin therapy. In the quantitative arm, biometric data (hemoglobin A1c [HbA1c] and weight) and psychosocial data (diabetes empowerment scale [DES] scores and diabetes distress scale [DDS] scores) were gathered by the research team at baseline (T1), the end of the intervention (T2), and 3 months postintervention (T3). Data on hospital admission and general practitioner (GP) visits were collected for the duration of the study. In the qualitative arm, separate focus group interviews were conducted with the CNS team supporting the intervention (n=2) and patients (n=16). Results Of 39 patients who completed the intervention, 23 (59%) were male. The mean age of the sample was 62.4 years (range 37-80 years). The mean HbA1c (mmol/mol) decreased significantly between T1 and T2 (mean difference [MD] −17.13; P<.001) and T1 and T3 (MD −18.16; P<.001), with no significant impact on weight. In the focus groups, patients reported an increased awareness to self-manage diabetes and feelings of safety and comfort. There were 13% (5/39) of patients who had hypoglycemia on two or more occasions. A significant increase in the mean DES score occurred between T1 and T2 (MD 0.62; P=.001) and T1 and T3 (MD 0.72; P<.001). The mean DDS score decreased between T1 and T2 (MD −0.64; P=.002) and T1 and T3 (MD −0.6; P=.002). The mean patient satisfaction with the intervention was above 4 out of possible 5 on all items on the Telemedicine Satisfaction and Usefulness Questionnaire. We observed a reduction in diabetes clinic attendances and GP visits. A significant increase in workload was reported by the CNS team. Conclusions This intervention had an empowering effect for patients in the self-management of type 2 diabetes and has the potential to meet the need for safer and more effective care in insulin initiation in the community setting. We observed a significant increase in workload for health care staff. Telemonitoring needs to be streamlined with health care delivery and accompanied by adequate support services.

Use of Virtual Care for Glycemic Management in People With Types 1 and 2 Diabetes and Diabetes in Pregnancy: A Rapid Review

“…With the exception of 2 trials of diabetes in pregnancy, all virtual interventions achieved absolute A1C reductions of !0.5% (Table 3). In 5 RCTs, there was a larger reduction in A1C in the intervention group compared with controls (16,21,30,38,59) at the longest follow up. Conversely, in 3 RCTs, no intergroup differences in A1C were reported at the longest follow up (11,18,19).…”

Human Connection and Technology Connectivity: A Systematic Review of Available Telehealth Survey Instruments

“…Table 2 provides a summary of respondent demographics according to telehealth survey instrument use. Telehealth survey instruments have primarily been used to assess patient experience (n=41, 91%) 23 , 24 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 with less frequent use to assess family caregiver (n=7, 16%) 28 , 34 , 37 , 40 , 65 , 66 or medical provider experience (n=8, 18%). 23 , 35 , 40 , 67 , 68 , 69 , 70 , 71 …”

Hypothesized mechanisms explaining poor prognosis in type 2 diabetes patients with COVID-19: a review

“…Finally, it could provide at home special cares for elderly and comorbid patients [ 181 ]. In this historical moment, the use of technologies appears certainly appropriated to better manage chronic clinical conditions, including DM [ 182 – 184 ]. Diabetic outpatients should be conveniently managed by means of telemedicine that includes several services such as emergency phone calls, social media messaging, teleconsulting and ambulatories should be fitted with technological tools according to patients ability, healthcare personnel characteristics and available economic resources [ 62 ].…”