Telemonitoring of people with poorly controlled non-insulin treated type 2 diabetes: A feasibility trial

Telemonitoring may support glycemic control in people with non-insulin-treated type 2 diabetes (T2D), but the optimal intervention design remains unclear. This feasibility trial aimed to evaluate two telemonitoring intervention designs as a supplement to usual care and to inform the design of a future randomized controlled trial.

A three-month randomized cluster feasibility trial was conducted across four municipalities in North Denmark. Adults with poorly controlled non-insulin-treated T2D (hemoglobin A1c (HbA1c) > 53 mmol/mol) were recruited through general practitioners. Participants were allocated by municipality to one of two telemonitoring designs. All participants monitored blood glucose, sleep, and mental health, while one intervention additionally included blood pressure and physical activity monitoring and were followed remotely for three months. Feasibility outcomes included recruitment, retention, questionnaire response rates, and adherence to blood sampling. Exploratory within-group changes in patient-reported outcomes and HbA1c were assessed.

Thirty participants were included, and 21 completed the trial. Questionnaire response rates were 100% at baseline and follow-up. Adherence to HbA1c blood sampling was 100% at baseline and 72.4% at three months. A significant improvement was observed in patient activation (PAM-13; p = 0.01) and median HbA1c decreased from 64.0 to 60.0 mmol/mol (p = 0.01). No significant changes were found in diabetes-related distress, health-related quality of life, or well-being. The primary reason for dropout was the burden of self-monitoring, particularly self-monitoring of blood glucose.

Telemonitoring was feasible and associated with improvements in glycemic control and patient activation in people with non-insulin-treated T2D. Recruitment challenges and a high dropout rate highlight the importance of minimizing participant burden in telemonitoring.