Summary: In a 6-month randomised controlled trial of 198 community-dwelling adults aged 65 and older with type 2 diabetes in China, a home telemedicine programme paired with Health Belief Model health education lowered HbA1c by 0.42% more than conventional care (95% CI 0.12% to 0.73%). Self-management, self-efficacy, and health-belief scores also improved, although the absolute glycaemic gain was modest and the trial was single-centre and unblinded.
PICO Summary
| Element | Detail |
|---|---|
| Population | 198 community-dwelling adults aged 65 years and older with type 2 diabetes; single-centre randomised controlled trial in China; 191/198 (96.5%) completed. |
| Intervention | Home telemedicine combined with health education based on the Health Belief Model, delivered over 6 months (intervention arm of the randomised sample). |
| Comparison | Conventional diabetes management programme (control arm of the randomised sample). |
| Outcome | Primary outcome HbA1c at 6 months: change of -0.99% (95% CI -1.60% to -0.60%) in the intervention group versus -0.42% (95% CI -0.90% to 0.90%) in controls; between-group difference -0.42% (95% CI 0.12% to 0.73%), favouring the intervention. Secondary outcomes favoured the intervention: self-management +5.88 (95% CI 4.98 to 6.79), self-efficacy +9.40 (95% CI 8.15 to 10.66), and health beliefs +19.54 (95% CI 17.71 to 21.36). Absolute risk reduction and number needed to treat were not reported for this continuous endpoint. |
Home telemedicine + HBM education in older T2D
RCT · type 2 diabetes · 65+ years · 6 months
Home telemedicine plus Health Belief Model education cut HbA1c 0.42% more than usual care over 6 months, a statistically robust but clinically modest gain in motivated older adults.
Expert Commentary
This randomised trial supports a real but modest benefit. A home telemedicine package with structured Health Belief Model education produced a between-group HbA1c reduction of 0.42% over six months, a change that is statistically robust given the confidence interval that excludes zero, yet clinically modest and broadly in line with other behavioural and digital self-management interventions. The accompanying gains in self-management, self-efficacy, and health beliefs are coherent and suggest the mechanism is engagement rather than pharmacology. Several cautions temper enthusiasm. The most important limitation is that the trial was unavoidably unblinded, because patients and educators knew which arm they were in, and self-reported behavioural scales are especially vulnerable to expectation effects in open-label designs. The work was single-centre, recruited over a short window, and the reported confidence interval for the control-group change spans zero in a way that hints at a reporting inconsistency, so external validation is needed. No commercial sponsorship was declared, and the effect size is plausible rather than implausibly large. Can I use this with my patients? Cautiously yes, for motivated older adults with type 2 diabetes who have reliable connectivity and a community health structure to support remote follow-up, as an adjunct rather than a replacement for usual care. Larger multi-centre trials with objective adherence measures should confirm durability before wider adoption.
References
Zhang A, Wang J, Wan X, Zhang Z, Zhao S, Bai S, et al. Community-based intelligent blood glucose management for older adults with type 2 diabetes based on the Health Belief Model: randomized controlled trial. JMIR Mhealth Uhealth. 2025;13:e60227. doi:10.2196/60227