JMIR Publications

ABSTRACT

Background:

People with type 1 diabetes require ongoing self-management and frequent follow-up care. Digital care models might offer flexible solutions and increased sustainability; however, the characteristics of patients inclined to opt for digital care remain unclear.

Objective:

To investigate which selected sociodemographic and disease-related patient characteristics are associated with the preference for digital outpatient care among patients with type 1 diabetes.

Methods:

We conducted a cross-sectional study of adult patients with type 1 diabetes in outpatient care at Akershus University Hospital's endocrinology department in Norway. Patients could choose either a novel mHealth-based digital tailored outpatient care model (DigiDiaS care) or continuation of usual care. DigiDiaS care is delivered via an app comprising a message service, pre-consultation questionnaires, options for physical, video, or telephone consultations, an information page, and an e-learning course. We collected sociodemographic and clinical data from medical records and the national diabetes registry. Patients completed a questionnaire with outcomes such as self-management, diabetes distress, well-being, and health literacy. We examined group differences and conducted logistic regression to identify factors associated with the preference for DigiDiaS care versus usual care.

Results:

A total of 237 patients consented to participate in the study, with 186 (78%) opting for DigiDiaS care and 52 (22%) opting for Usual care. When comparing the two groups in a multi variate logistic regression, the DigiDiaS care group had a statistically significant shorter duration of diabetes (median 19 years, min;max 0;51) compared to the Usual care group (median 29 years, min;max 3;58, P < .001), higher proportions of users of insulin pumps than insulin pens (DigiDiaS care: n = 74, 40%; Usual care: n = 12, 23.1%, P = .007), and a lower median well-being care score (DigiDiaS care: median score 60, min;max 4;96; Usual care: median score 68, min;max 16;100, P = .039). DigiDiaS care and Usual care groups did not differ in sociodemographic variables, presence of late complications or comorbidities from diabetes, self-management, diabetes distress, or health literacy. Furthermore, we compared our study sample with the hospital sample and national population of people with type 1 diabetes, finding comparability on gender, education, insulin administration, HbA1c, age, and diabetes duration, but our sample comprised a higher proportion of individuals with HbA1c ≥ 75 mmol/mol.

Conclusions:

This study reveals that patients with type 1 diabetes prefer digital outpatient care, highlighting the potential for personalized and flexible care. Those preferring DigiDiaS care are already familiar with using diabetes-related technology and have a shorter diabetes duration. It is essential to understand the characteristics of patients who prefer usual care to ensure that digital health interventions remain inclusive and accessible. Further studies should also focus on how the implementation of digital solutions in outpatient care can affect how and if patients use them.