A Nurse-Led Telemonitoring Approach in Diabetes During the COVID-19 Pandemic: Prospective Cohort Study

Stephanie A Noonan; Amanda L Gauld; Maria I Constantino; Margaret J McGill; Timothy L Middleton; Ian D Caterson; Luigi N Fontana; Stephen M Twigg; Ted Wu; Raaj Kishore Biswas; Jencia Wong

doi:10.2196/68214

A Nurse-Led Telemonitoring Approach in Diabetes During the COVID-19 Pandemic: Prospective Cohort Study

JMIR Diabetes. 2025 Aug 8:10:e68214. doi: 10.2196/68214.

Authors

Stephanie A Noonan^{1

2}, Amanda L Gauld¹, Maria I Constantino^{1

2}, Margaret J McGill^{1

2}, Timothy L Middleton^{1

2}, Ian D Caterson^{1

2}, Luigi N Fontana², Stephen M Twigg^{1

2}, Ted Wu¹, Raaj Kishore Biswas^{3

4}, Jencia Wong^{1

2}

Affiliations

¹ Diabetes Centre, Royal Prince Alfred Hospital, Level 6 West, 50 Missenden Road, Sydney, NSW, 2050, Australia, 61 295155888, 61 295155820.
² Central Clinical School, Faculty of Medicine and Health and the Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
³ School of Health Sciences, Faculty of Medicine and Health and the Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
⁴ Sydney Local Health District Clinical Research Centre, Sydney, NSW, Australia.

PMID: 40779770
PMCID: PMC12334113
DOI: 10.2196/68214

Abstract

Background: The utility of a nurse-led telemonitoring approach (NLTA) is yet to be firmly established in diabetes management.

Objective: 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.

Methods: 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).

Results: 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).

Conclusions: 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.

Keywords: COVID-19; HbA_1c; anxiety; depression; diabetes distress; diabetes models of care; glycemia; health care delivery; nurse-led; psychological risk; quality of life; surveillance; telehealth; telemedicine; telemonitoring; virtual.

© Stephanie A Noonan, Amanda L Gauld, Maria I Constantino, Margaret J McGill, Timothy L Middleton, Ian D Caterson, Luigi N Fontana, Stephen M Twigg, Ted Wu, Raaj Kishore Biswas, Jencia Wong. Originally published in JMIR Diabetes (https://diabetes.jmir.org).