The solution proposed in the article written by Kotsani et al. (2018) is telenursing. Telenursing is comprised of a set of practices aimed at maintaining appropriate home care without the need to a hospital. These practices include consultation, review of blood analyses taken domestically, provision of training and advice required by patients to manage their symptoms, motivation and reinforcement, and information support on the subject of t1DM (Kotsani et al., 2018). The practice is rooted in Orem’s theory of self-management, and seeks to alleviate the pressure off of hospitals while empowering the patient to exhibit greater autonomy and encourage decision-making when managing one’s own health (Kotsani et al., 2018). In the scope of the reviewed study, the test group received weekly phone calls, received assistance in measuring glucose levels, and was instructed on how to lead a healthier lifestyle.
Population selection criteria was formulated in regards to the absence of knowledge on the subject as well as the prevalence of the disease among different age groups of people (Kotsani et al., 2018). Since diabetes studies are overwhelmingly focused on the elderly patients, and the average age of an individual with Type 1 DM is between 19 and 39 years old, that diapason was chosen to represent the majority of individuals receiving outpatient care (Kotsani et al., 2018). t1DM affects insulin intake, soliciting different ways of its management. Multiple daily injections (MDI) was the chosen method of self-care, as insulin pumps and continuous glucose intake procedures required less instructions or allowed for limited patient autonomy in the first place (Kotsani et al., 2018).
The chosen sample included 94 participants, which were split into the intervention and control groups. The reasons why the control group was slightly smaller was because some participants were deemed ineligible or refused to participate (Kotsani et al., 2018). In the intervention group, the average participant age 26.35 years, and 27.63 years for the control group. The average length of enduring diabetes was about 15 years for both. Male and female representation was roughly equal, with 25-23 and 22-24 balance between the two cohorts (Kotsani et al., 2018). The majority of patients were unmarried and living with parents or housemates. Two thirds of the population were students or otherwise unemployed, with only one third having either a part-time or a full-time job. The average morning blood, pre-prandial, and post-prandial blood glucose levels were slightly increased in the intervention group, by roughly 20-30 mg/dl (Kotsani et al., 2018).
Control group had patients whose overall glucose levels were lower by 20-30 mg/dl on average (Kotsani et al., 2018). They did not receive the telemedicine intervention reserved for the control group, and operated using the standard routine, which included infrequent visits to the hospital, and self-management of symptoms using the information received during those visits. While their glucose levels were lower than they were in untreated cases, they did not show any significant improvement in reducing glucose levels in one’s blood, throughout the intervention (Kotsani et al., 2018). Such results indicate a skill ceiling for patients trying to manage their symptoms unassisted, which cannot be overcome without additional support (Kotsani et al., 2018).
Research findings for the intervention group showed remarkable results. Average glucose levels for morning blood sugar dropped from 120 mg/dl to around 93 mg/dl (Kotsani et al., 2018). Pre-prandial glucose levels have dropped from 148 mg/dl to 114 mg/dl, and post-prandial blood glucose levels dropped from 248 mg/dl to 193 mg/dl (Kotsani et al., 2018). These significant blood sugar level decreases were achieved in only 2 months, without invasive procedures or strong medical drugs. As it was discovered, the primary reasons for such results were the increased compliance of patients to the prescribed treatments, increased skill in administering glucose, and the adoption of a healthier way of life (Kotsani et al., 2018). These factors contributed to improvements in the quality of life for the majority of the patients.
The results presented in the study by Kotsani et al. (2018) provide some evidence of effectiveness of telemedicine for t1DM patients. However, there are some limitations to the interpretation of the results. The primary issue is with the initial glucose levels in patients. It was shown that the test group had, on average, 20-30 mg/dl more glucose than the control group (Kotsani et al., 2018). While the achieved 30-40 mg/dl drop is impressive, it is only 10 m
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