Noonan Stephanie A, Gauld Amanda L, Constantino Maria I, McGill Margaret J, Middleton Timothy L, Caterson Ian D, Fontana Luigi N, Twigg Stephen M, Wu Ted, Biswas Raaj Kishore, Wong Jencia
Diabetes Centre, Royal Prince Alfred Hospital, Level 6 West, 50 Missenden Road, Sydney, NSW, 2050, Australia, 61 295155888, 61 295155820.
Central Clinical School, Faculty of Medicine and Health and the Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
JMIR Diabetes. 2025 Aug 8;10:e68214. doi: 10.2196/68214.
The utility of a nurse-led telemonitoring approach (NLTA) is yet to be firmly established in diabetes management.
This study aims 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 to evaluate it as a new diabetes model of care.
The telemonitoring study group (TSG; n=91) comprised adults who had attended an Australian tertiary hospital diabetes center between January 2019 and March 2020. Telehealth surveillance contact with a diabetes nurse educator was subsequently maintained at approximately 3-month intervals over 12 months. Prospective surveillance measures included glycated hemoglobin A1c (HbA1c%), weight, adherence to healthy behaviors, and patient-reported outcomes of diabetes distress, anxiety, and depression using validated instruments. Metabolic changes were compared retrospectively with a comparison group who had not received telemonitoring contact during the study period (non-TSG; n=115).
The average participant age was 57.2 (SD 15) years; 63% (129/206) were male, 48% (99/206) had type 1 diabetes, 50% (104/206) had type 2 diabetes, and the mean HbA1c% was 8.1% (SD 1.4%). At the end of the 12-month study, the relative percentage reduction in unadjusted HbA1c% for the TSG cohort was significantly greater than that observed in the non-TSG cohort (4% vs 1%; P=.04). Following adjustment for baseline HbA1c%, a significant improvement in HbA1c% was observed in the TSG (P=.048) but not in the non-TSG (P=.61). TSG participants were 40% less likely (odds ratio 0.6, 95% CI 0.5-0.7) to experience an unfavorable rise in HbA1c% compared to non-TSG participants, after adjusting for sex, age, prepandemic HbA1c%, ethnicity, diabetes type, and diabetes duration. The NLTA facilitated assessments of psychological risk, with elevated depression, anxiety and diabetes distress scores significantly increased in women and youth <30 years of age (P<.001). Increasing anxiety measures were observed in those with high baseline anxiety scores (P<.001).
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 demand for diabetes-related resources, further study of an NLTA model of care is warranted.
在糖尿病管理中，由护士主导的远程监测方法（NLTA）的效用尚未得到确证。
本研究旨在探讨在新冠疫情期间，为期12个月的主动式NLTA对糖尿病患者代谢和心理健康指标的影响，并将其评估为一种新的糖尿病护理模式。
远程监测研究组（TSG；n = 91）由2019年1月至2020年3月期间在澳大利亚一家三级医院糖尿病中心就诊的成年人组成。随后，在12个月内，每隔约3个月与糖尿病护士教育者进行一次远程健康监测联系。前瞻性监测指标包括糖化血红蛋白A1c（HbA1c%）、体重、健康行为依从性，以及使用经过验证的工具由患者报告的糖尿病困扰、焦虑和抑郁结果。将代谢变化与研究期间未接受远程监测联系的对照组（非TSG；n = 115）进行回顾性比较。
参与者的平均年龄为57.2（标准差15）岁；63%（129/206）为男性，48%（99/206）患有1型糖尿病，50%（104/206）患有2型糖尿病，平均HbA1c%为8.1%（标准差1.4%）。在为期12个月的研究结束时，TSG队列未经调整的HbA1c%相对降低百分比显著大于非TSG队列（4%对1%；P = 0.04）。在对基线HbA1c%进行调整后，TSG组的HbA1c%有显著改善（P = 0.048），而非TSG组则无显著改善（P = 0.61）。在对性别、年龄、疫情前HbA1c%、种族、糖尿病类型和糖尿病病程进行调整后，与非TSG参与者相比，TSG参与者HbA1c%出现不利升高的可能性降低了40%（优势比0.6，95%置信区间0.5 - 0.7）。NLTA有助于心理风险评估，女性和年龄<30岁的青年抑郁、焦虑和糖尿病困扰评分显著升高（P<0.001）。基线焦虑评分高的人群中焦虑测量值增加（P<0.001）。
一种主动式糖尿病NLTA是可行的，对血糖有积极影响，并且有潜力识别出有心理风险的人群以便进行针对性干预。在对糖尿病相关资源需求不断增加的背景下，有必要对NLTA护理模式进行进一步研究。
