As digital health technology advances, telehealth is increasingly used to augment the management of diabetes. Telemedicine is a promising intervention for the diabetes patient population because it allows for advanced and accurate monitoring of blood glucose, while also fostering improved medication adherence. However, for these benefits to materialize, patients must be engaged with the technology. A recent study addressed this point by examining the role of patient participation in the success of a diabetes telehealth program.

The Influence of Patient Engagement on Patient Outcomes

Patient participation in a telehealth program is a critical determinant of program success. A patient’s willingness to engage in a telehealth program is influenced by perceived usefulness of the technology and perceived ease of use. In addition, patient activation, which is defined as a patient’s understanding of his or her role in the care process, also contributes to participation. A recent study explored the role of these two factors in a telehealth program for diabetes management.

The study’s authors collected data from a group of patients with type 2 diabetes who used remote patient monitoring technology for three months. Their primary goal was to understand how patient activation and engagement with the technology influenced diabetes management outcomes. The outcomes were determined by comparing the changes in hemoglobin A1c (HbA1c) at the start of the program and after program completion.

How Eager are Patients to Participate in Telehealth?

The remote patient monitoring program featured in the study took place at Nebraska Medicine, a top rated hospital in Nebraska. Patients with type 2 diabetes who were recently hospitalized were recruited to the program within one month of hospital discharge. The three month remote patient monitoring program included daily remote monitoring of biometric data (blood pressure, weight, and glucose level) and a minimum of one weekly phone call with a nurse. Additional calls with nurse coaches were conducted when an alert was triggered from the monitoring system.

As part of the remote patient monitoring program, nurse coaches administered interventions such as, medication adherence assessment, nutritional counseling, weight measurement, and disease self-management support. In addition, a certified diabetes educator provided participants with their HbA1c data and administered a virtual foot examination at baseline and at program completion. Also, patients who completed the program received diabetic retinopathy screening at a local community health center. 

The primary outcome of the study was HbA1c, which was measured at baseline and program completion. The patients were divided into two groups according to their HbA1c levels: HbA1c greater than 9% (poor glycemic control) and HbA1c less than or equal to 9%.

The authors used the Patient Activation Measure -13 (PAM-13) to compare the degree of patient activation at baseline and at the end of the remote monitoring program. The PAM-13 consists of 13 questions that measure patient knowledge, skill, and confidence for self-management of chronic conditions. Based on PAM-13 scores, the authors divided patients into four levels, with level 1 indicating the least confidence and knowledge in managing health and level 4 indicating that the patient is actively managing his or her own health.

Patient engagement was measured according to the frequency of uploads of biometric data. Patients were divided into five quintiles of upload frequency, ranging from 0 uploads per day to over 1 upload per day. The first three quintiles were classified as low engagement and the fourth and fifth quintiles were labeled as high engagement.

Maximizing the Potential of Telehealth for Diabetes Patients

patient engagement 1

A total of 1,354 patients completed the three month remote patient monitoring program. The average HbA1c of all patients at baseline was 7.7%. This measure fell to 7.1% by the end of the program.

One of the most notable findings from the study was the negative correlation between baseline patient activation and post-program HbA1c. Overall, as the patient activation levels increased, post-program HbA1c decreased. This result indicates that the more empowered and confident patients felt in managing their health, the more likely they were to experience improved outcomes.

In addition, there was a negative association between the frequency of patient data uploads and post-program HbA1c. The authors of the study found that the patients who most frequently participated in remote monitoring had lower HbA1c at the end of the program. When compared to patients who only uploaded their biometric data every two days or less, the patients who uploaded at least once per day were less likely to present with HbA1c greater than 9% at the end of the program.

Empowering Patients to Participate in Remote Monitoring

The authors concluded that higher levels of patient activation and engagement with the remote patient monitoring technology were associated with improved patient outcomes and hypoglycemic control. These results support the development of targeted interventions that address patient activation and engagement in diabetes management. As providers begin to incorporate interventions that directly influence patient participation, we are sure to see even greater success of remote patient monitoring programs.



Su D, Michaud TL, Estabrooks P. et al. Diabetes Management Through Remote Patient Monitoring: The Importance of Patient Activation and Engagement with the Technology. Telemed J E Health. 2018 Oct 27.