Home blood sugar testing with telehealth support a hit among patients in SG

Patients with type 2 diabetes (T2D) in Singapore appear to welcome the convenience of home HbA1c testing paired with telehealth support.

In a feasibility study, the Primary Technology Enhanced Care (PTEC) Home HbA1c Testing (HAT) Programme, which involved home HbA1c testing by patients coupled with telemonitoring and teleconsultations by the care team, was well received. Most of the participants (81.3 percent) indicated that home HbA1c testing was beneficial, largely because it eliminated the need for a clinic visit (68.7 percent). [BMC Prim Care 2024;25:127]

More than half of the participants (59.4 percent), however, reported some difficulties using the home test kit, with the transmission of readings via Bluetooth being the biggest challenge (43.7 percent), followed by having to remember too many steps to complete the test (28.1 percent).

A key finding was that the number of diabetes-specific clinic visits declined 6 months after implementing the program, according to the investigators. The HbA1c values remained relatively stable between 6 months before and 6 months after the intervention, and the blood pressure (BP) levels showed a promising downward trend.

“Our results of clinical outcomes were largely aligned with a controlled trial which reported improvement in both HbA1c and BP at the end of 6 months of follow-up… Hence, in concordance with existing literature, our findings of maintenance of glycaemic control and improvement in both systolic and diastolic BP support the use of home HbA1c testing combined with telemonitoring and teleconsultation for diabetes management and the potential achievement of favourable clinical outcomes,” the investigators said. [Clin Diabetes 2020;38:230-239]

“However, we do acknowledge that our findings of HbA1c and BP were not statistically significant which is due to the feasibility nature of current study with limited sample size,” they added.

Satisfactory intervention

Overall, participants reported satisfaction with different components of the PTEC HAT Programme, including the medical advice that they received through phone consultations (87.5 percent) and the convenience of submitting their HbA1c measurements to their care team by clicking “submit” button (53.1 percent). More than three-fourths of the participants (75.0 percent) felt that their care team understood their condition well due to having access to the readings which the participants themselves took at home. Finally, 46.9 percent of participants felt motivated to control their blood sugar better in this program.

“All participants in our feasibility pilot were able to complete the home HbA1c test with differing levels of assistance provided by the care team… Similar to our findings, a US-based feasibility study reported that patients with T2D were able to successfully complete at least one home HbA1c test, but the participants required assistance either via phone or Zoom meeting,” the investigators noted. [Sci Diabetes Self-Management Care 2022;48:204-212].

A total of 33 individuals with diabetes completed the intervention and were included in the feasibility study. Most of them were either 51–60 years (46.9 percent) or more than 60 years (37.5 percent) of age, men (53.1 percent), and of Chinese ethnicity (93.8 percent). Hyperlipidaemia was the most common comorbid condition (81.5 percent), followed by hypertension (63.0 percent). The mean Michigan Diabetes Knowledge Test (DKT) score was 53.0, with about 15.6 percent of patients having good knowledge of diabetes.

For the intervention, the participants were asked to record their HbA1c and BP readings, once every 3 to 6 months for HbA1c and once a week for BP, via the patient-facing smartphone app, which also provided educational materials. The readings from Bluetooth-enabled HbA1c device were directly detected by the PTEC HAT app and automatically transmitted to the care team, who could access them via the dashboard function on patient management portal. The patients received immediate alerts, advice, and reminders via an in-app chatbot, which also facilitated communication to their care team.

Considerations for the scaling phase

“While the most common reported error in this study was the inadequacy of the blood sample, our findings highlighted the Bluetooth transmission issue as the central pain point for the participants,” the investigators pointed out.

“Hence, to increase the adoption of the PTEC HAT Programme in the subsequent implementation scaling phase, it is important to address this barrier and make the transmission of readings effortless and easy. One solution for the implementation scaling phase would be for the study team to explore alternative modes of transferring their readings, for example, via optical character reading (OCR) or manual submission,” they added. [Front Artif Intell 2021;4:543176]

In addition, providing educational resources such as user-friendly instructional videos and accompanying guides can help address potential cognitive load issues and enhance patient compliance and program adoption in the scaling phase, the investigators said.