Diabetes Remote Patient Monitoring and Education in a Rural Setting

Background: Diabetes is a complex and chronic disease that can be extremely difficult for individuals to manage, especially without the support of a specialized diabetes healthcare team. Diabetes education services can help provide much-needed support, but only about half of people with diabetes have ever received formal diabetes education. Remote patient monitoring (RPM) is a method used to remotely transfer medical data between patients and healthcare providers, allowing for more convenient care and support. This quality improvement (QI) project aimed to develop a diabetes RPM program for adults with diabetes in rural Utah. Methods: This QI project focused on the process of creating a diabetes RPM program then trialing it with a small sample of individuals to determine if it was feasible, usable, and if participants were satisfied. The program site was in rural Uintah, Duchesne, and Daggett Counties for patients of Uintah Basin Healthcare (UBH). Six adults with diabetes utilizing insulin pumps were enrolled in the six-week program. The UBH Certified Diabetes Care & Education Specialist (CDCES) assisted participants with creating a UBH patient portal account and remotely uploading their insulin pumps from home weekly for the primary care provider (PCP) to review. The CDCES also sent diabetes education resources to participants via the patient portal each week. Resources included recorded diabetes education videos covering the topics of healthy coping, healthy eating, being active, taking medications, monitoring, problem solving, and reducing risks. In addition, participants completed standardized pre- and post-intervention surveys including the Type 1 Diabetes Distress Scale and the Revised Brief Diabetes Knowledge Test. The standardized Diabetes Treatment Satisfaction Questionnaire and a free-response feedback survey were also included in the post-intervention surveys. Although this study was underpowered to detect a change in patient-reported outcome measures over the six-week study period, these data were used to provide a description of the sample characteristics. Results: At the conclusion of the six-week intervention, key findings included high participant program satisfaction and a high retention rate. Participants reported the program made communication easier for those who would otherwise need to travel long distances to meet with a healthcare provider and diabetes educator. Overall, the participants had moderately high knowledge scores pre- to post-intervention. The program was feasible, especially since handouts and recorded education videos can be used for future diabetes RPM participants. Conclusions: In this project, videos and processes were developed to conduct a diabetes RPM program. Initial results indicate the program was feasible, usable, and acceptable. More study in a larger sample is needed to determine if this diabetes RPM program can improve glycemic and psychosocial outcomes in people with diabetes in rural Utah.