Abstract:
BACKGROUND
Type 2 diabetes (T2D) self-management requires ongoing lifestyle changes, yet many patients struggle to maintain healthy habits. While telehealth and coaching can help, there is limited understanding of how to adapt interventions to patients’ evolving needs.
OBJECTIVES
We aim to characterize patients’ experiences with T2D self-management by integrating insights on lifestyle behaviors, self-monitoring practices, and medication adherence with longitudinal HbA1c and clinical trends.
METHOD
We analyzed anonymized clinical data from 1,599 patients with T2D from the SingHealth Diabetes Registry (SDR) in Singapore. Using state sequence analysis, patients were segmented based on their 18-month HbA1c trajectories. To complement this analysis, we conducted content analysis of 807 transcribed telecarer-patient calls from 162 participants in a telehealth program at a tertiary hospital, noting mentions of self-management behaviors. From this cohort, 20 patients were purposively sampled across the identified HbA1c trajectory segments for in-depth thematic analysis of 115 telehealth conversations guided by the Capability, Opportunity, and Motivation Theoretical Domains Framework (COM-B/TDF) [1]. By integrating qualitative themes and lifestyle insights with longitudinal clinical data, we enabled a comprehensive exploration of how patient experiences, self-management behaviors, and clinical outcomes interrelate over time.
RESULTS
Five segments with distinct HbA1c trajectories emerged from the analysis, reflecting patterns of well-controlled, mixed-controlled, and poorly controlled glycemic outcomes. Despite these differences in HbA1c control, self-reported self-management behaviors were largely consistent across the segments. Most patients reported taking their medication (93%), with 69% monitoring their diet, 66% engaged in self-monitoring of blood glucose (SMBG), 48% refraining from smoking, 44% avoiding alcohol, and 41% reported doing some form of exercise. Notably, self-reports of SMBG were highest in the well-controlled segment (80%), compared to 55% in the poorly controlled segment (even though 72% in the latter segment reported having a glucometer at home).
Across segments, patients described various facilitators and barriers to T2D self-management. While many expressed intentions to monitor blood glucose and control HbA1c, they often encountered challenges such as forgetfulness, misconceptions about SMBG, complacency, low self-confidence, and fear of pain from finger pricks. Patients with caregiver supervision, social support, and access to glucometers found these factors helpful in supporting regular self-monitoring.
Over time, patients’ experiences with T2D self-management diverged. Some effectively integrated SMBG, dietary control, exercise, and medication adherence into daily routines, enabling them to manage hypo- and hyperglycemic symptoms well. However, others struggled to maintain consistent monitoring due to irregular work schedules. For some, lifestyle non-compliance further disrupted structured SMBG practices. Additionally, work-related stress, family responsibilities, and financial constraints limited the capacity for sustained self-care, contributing to poorer glycemic control. In several cases, patients with initial good adherence experienced a decline in consistency over time, particularly as complications arose, which in turn increased reliance on family or caregivers for support.
CONCLUSION
Our analysis revealed that patients’ 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.
REFERENCES
[1] Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science, 6(1), 42.