JMIR Publications

ABSTRACT

Background:

The utility of a nurse-led telemonitoring approach (NLTA) is yet to be firmly established in diabetes management.

Objective:

To examine the effect of a 12-month proactive NLTA on metabolic and psychological health-indices in individuals with diabetes during the COVID-19 pandemic, and as a new diabetes model-of-care.

Methods:

The telemonitoring study-group (TSG n=91) comprised adults who had initially attended a tertiary hospital Australian Diabetes Centre between January 2019-March 2020. Telehealth surveillance contact with a diabetes nurse educator was subsequently maintained at ~3 monthly intervals during the pandemic response period; surveillance measures included HbA1c%, weight, adherence to healthy-behaviours and patient-reported outcomes of distress, anxiety and depression using validated instruments. Metabolic changes were compared retrospectively with a comparison-group (non-TSG n=115) who had not received contemporaneous telemonitoring contact.

Results:

At the end of the 12-month study, the relative percentage reduction in unadjusted HbA1c% for the TSG cohort was significantly greater than the non-TSG cohort (3.8% vs 1.2%; p = .043) by between group analysis of covariance (ANCOVA). Further adjusting for pre-pandemic HbA1c% for each cohort separately across time, there was an overall significant improvement in HbA1c% for the TSG (p = .048) dissimilar to the non-TSG (p = .61). TSG participants were 40% less likely (OR: 0.6, 95% CI: 0.5–0.7) to experience an unfavourable rise in HbA1c% compared to the non-TSG participants after adjusting for sex, age, pre-pandemic HbA1c%, ethnicity, diabetes type, and diabetes duration. The NLTA facilitated assessments of psychological risk, with elevated depression scores significantly increased in women and in youth < 30 years-of-age (p <.001). Increasing anxiety-measures were observed in those with high baseline anxiety scores (p <.001).

Conclusions:

A proactive diabetes NLTA is feasible with positive effects on glycemia and the potential to identify those at psychological risk for targeted intervention. In the context of increasing diabetes-resource demand, further study of a NLTA model of care is warranted. Clinical Trial: This study was approved by the Ethics Review Committee (HREC/X20/RPAH/0206) of the Sydney Local Health District.