title: An Analysis of Type 2 Diabetes Interventions
Creators: name: De Groot, Julia A
Publisher: name: Griffith University
Year: 2022
Subjects: subject: Telehealth
subject: Telemedicine
subject: Telemonitoring
subject: Behavioural change
subject: Self-management
subject: Diabetes

description: Background Type 2 diabetes is a type of chronic and progressive metabolic disorder characterized by persistent hyperglycaemia. It is associated with numerous complications, a high burden of disease, and large economic costs. This thesis intends to explore the existing knowledge about current and emerging interventions for type 2 diabetes, aiming to identify and fill in some of the current gaps in the literature. Currently, telemedicine has become increasingly popular as a convenient and cost-saving method of intervention. However, in-depth analysis of telemedicine for various health outcomes and sub-groups about intervention characteristics are not well explored. Furthermore, the selfmanagement paradigm intends to develop the patient’s own ability to respond to the disease physically, cognitively, and emotionally. This thesis features an analysis of the importance of self-care, self-efficacy, and diabetes knowledge in type 2 diabetes, and how a self-management intervention affects these parameters in comparison to a control. Methodology Paper 1 of this thesis consisted of a published systematic review and meta-analysis, which explored the effect of telemedicine interventions for type 2 diabetes by comprehensively searching the literature. Glycaemic control and other biomedical outcomes were compared between the intervention and control using mean difference. Furthermore, subgroup analysis investigated the effect of patient demographics, changes to self-care behaviours, and characteristics of the intervention on change to glycaemic control. Paper 2 was a randomised controlled trial, which is prepared for publication. This examined the effect of a self-management intervention on outcomes of self-care behaviours, self-efficacy, and diabetes knowledge. The intervention group received 10 fortnightly group sessions aimed at self-management of the disease, whilst the control received a single 2-hour education session. Binomial logistic regression was used to compare the intervention and control groups, at baseline, 26 weeks, and 52 weeks. Results The systematic review and meta-analysis included 43 studies, which found that glycosylated haemoglobin (HbA1c), diastolic blood pressure (DBP), post-prandial glucose (PPG), fasting plasma glucose (FPG), weight, body mass index (BMI), mental and physical quality of life (QoL) were improved in the telemedicine interventions more than the control. Systolic blood pressure (SBP) and cholesterol were not significant between the groups. Subgroup analysis revealed that patient demographics of obesity and Hispanic racial background had significantly higher benefits to glycaemic control post-telemedicine intervention. The intervention characteristics that were most effective for improving glycaemic control were: clinical treatment models, telemonitoring, videoconferencing, interactive telephone systems, a delivery of less than weekly, led by allied health, lasted for a duration of 6 months, focussed on biomedical parameters, had an engagement level of &gt;70%, with a drop-out rate of 10-19.9%. As for self-care behaviours, higher post-intervention self-blood-glucose monitoring and self-efficacy were associated with improved glycaemic control. The randomised control trial found that the intervention was alike the control for most outcomes. However, the intervention was superior for improving self-monitoring of the foot, and possibly for daily sock changes at the 52 weeks. Grouping by time analysis found that the intervention was more effective at improving foot care behaviours over time, which may lead to reduction in diabetic foot-related complications. Interestingly, the control was slightly superior to the intervention for improving overall diabetes knowledge. Although analysis of individual questions showed that control was better for improving knowledge about the normal range of fasting glucose, BMI and blood pressure, and the self-management intervention was better for developing ability to take appropriate actions, which is reflective of developing self-management. For selfefficacy, the intervention is possibly better than control for improving ability to do daily activities normally affected by depression. Conclusion Telemedicine is an effective measure for improving glycaemic control and other healthrelated outcomes in type 2 diabetes patients. The current research suggests that it is likely superior to controls, and subgroup analysis completed in paper 1 helps to inform decision-making for change of practice in widely accepted type 2 diabetes management. Self-management interventions are at least as effective as traditional interventions and show promise for being superior for improving factors such as self-care, and selfefficacy.