Evaluating the efficacy of a telehealth management model for chronic diabetes in resource-constrained regions.

OBJECTIVE

To assess the effects of a telehealth-enhanced integrated county-township-village management model (hereafter referred to as the telehealth management model) on metabolic indicators and chronic complications of rural-dwelling individuals with diabetes mellitus (DM), seeking an effective chronic disease management approach for regions with limited medical resources.

METHODS

An exploratory quasi-experimental study was conducted in Dafang County, Guizhou Province. Three townships were assigned to the management group, while the remaining townships constituted the control group. The management group participated in a 12-month diabetes intervention using a telemedicine platform for comprehensive care, while the control group received standard outpatient follow-up. Key indicators measured before and after the intervention included fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG), haemoglobin A1c (HbA1c), blood lipids, blood pressure, body mass index (BMI), the incidence of new chronic complications, and the pass rate on a diabetes knowledge assessment. Statistical analyses, including descriptive analyses for patient characteristics, multivariable regression for associations and adjusted effects, subgroup and restricted cubic spline analyses for heterogeneous and nonlinear relationships, and a propensity score matching combined with difference-in-differences (PSM-DID) approach to estimate the causal effect of the intervention, were performed.

RESULTS

In this study including 215 patients (88 in the management group and 127 in the control group), compared with the control group, the management group showed significant improvements after 12 months, including lower FBG (8.97 vs. 10.77), 2hPG (13.30 vs. 16.96), HbA1c (7.84 vs. 9.45), triglyceride (TG, 1.84 vs. 2.43), and BMI (23.94 vs. 26.09) levels and higher high-density lipoprotein cholesterol (HDL-C, 1.26 vs. 1.10) levels (all P < 0.05). They also had fewer new chronic complications (8.0% vs. 29.9% in the control group; P < 0.001). Multivariate analysis and PSM-DID analysis demonstrated an association between the management group and improved glycaemic control, and a reduction in the incidence of new complications.

CONCLUSION

Compared to standard of care, the telehealth management model improved patients' metabolic indicators, decreased complication risks, and strengthened primary health care services. This model provides a replicable example for the scalable implementation of integrated diabetes management in similar underdeveloped regions.