JMIR Publications

ABSTRACT

Background:

Initiation onto insulin therapy for the management of type 2 diabetes can be an unwelcome and distressful development for patients. Current evidence suggests that telemonitoring can play an integral role in improving glycaemic control in type 2 diabetes and can support empowerment to self-manage. The evaluation of this telemonitoring intervention was underpinned by an empowerment approach. An intervention can be deemed to have an empowerment approach if it supports patient autonomy and the development of self-awareness, attitudes, knowledge and skills to engage in self-management.

Objective:

The principle aim of this study is to evaluate the clinical effectiveness and feasibility and the patients’ and healthcare providers’ experiences of a 12-week telemonitoring intervention with telephone support in patients commencing insulin therapy. This paper focuses on the impact on patient empowerment.

Methods:

A multimethod, triangulation design was employed to study a telemonitoring intervention with telephone support from the Diabetes Clinical Nurse Specialist (CNS). Forty patients participated in the study. In the quantitative arm, biometric data (HbA1c, weight) and psychosocial data (diabetes empowerment scores (DES) and diabetes distress scores (DDS)) were gathered at baseline (T1), end-intervention (T2) and three-months post intervention (T3). Hospital admission and GP visit data were collect for the duration of the study. In the qualitative arm separate focus group interviews were conducted with the Clinical Nurse Specialists (CNS) supporting the intervention (n=2) and patients (n=16).

Results:

Thirty-nine patients completed the intervention of which 57.5% (n=23) were male. Mean age of the sample was 62.4 years (range 37-80 years). Mean HbA1c (mmols/mol) decreased significantly between baseline (T1) and end-intervention (T2) (MD -17.13 P < .001) and T1 and 3 months’ post intervention (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 along with increased knowledge, confidence and competence. They also reported feelings of safety and comfort. A significant increase in mean DES occurred between T1 and T2 (MD 0.62 p =.001) and T1 and T3 (MD 0.72 P < .001). Mean DDS decreased between T1 and T2 (MD -0.64 p =.002) and T1 and T3 (MD -0.6 p =.002). Mean patient satisfaction with the intervention was above 4 out of a possible 5 on all items on the Telemedicine Satisfaction and Usefulness Questionnaire (TSQ)

Conclusions:

Telemonitoring support for patients transitioning to insulin therapy has an empowering effect for patients in the self-management of type 2 diabetes and allows for safer and more effective care delivery in the community setting.