Abstract:
Background: Patients with type 2 diabetes (T2D) face self-management challenges. While telehealth and coaching interventions are beneficial, there is a gap in understanding how to adapt these interventions to patients’ evolving needs.
Aim: We characterized patients' real-life experiences with self-monitoring of blood glucose (SMBG), considering HbA1c trends, lifestyle, medication adherence, and clinical indicators over time in a telehealth program.
Method: We analyzed real-world data comprising medical records and telecarer-patient conversations from 1,599 T2D patients in a telehealth program at a tertiary hospital in Singapore. We segmented patients by 18-month HbA1c trajectories using state sequence analysis. We sampled 20 patients across segments for thematic analysis of their 115 telehealth calls using the Capability, Motivation, and Opportunity Theoretical Domains Framework. We linked resulting themes to clinical data for longitudinal analysis.
Results: We found 5 segments with well-, mixed-, and poorly-controlled HbA1c trajectories. Patients had good intentions to perform SMBG and control HbA1c, but demonstrated forgetfulness, misconceptions, complacency, low confidence, and fear of pain and bruising from self-pricking. Patients benefited from caregiver supervision, social support, and easy access to a glucometer.
Over time, we observed diverse experiences. Lifestyle non-compliance undermined structured SMBG for some patients. Some patients effectively balanced SMBG, diet, exercise, and medication, managing hypo/hyperglycemic symptoms well; for others, busy and irregular work schedules complicated regular SMBG. Work, family, and financial pressures limited self-care, leading to poor control. Good initial compliance became inconsistent due to complications, increasing the need for family/caregiver support.
Conclusion: Our analysis revealed that patient needs evolve with disease progression, requiring adaptable support structures. These insights highlight the importance of developing approaches to enhance personalized telehealth interventions that are holistic, incorporating mental health and social support.