Telehealth and Mobile Diabetes Nursing in Rural Sweden

Monika Lund, Edwin Barlow, Karin Johansson, Eva Melin, Hans Thulesius, Viveca Ritsinger

Keywords: Telehealth, Diabetes Nursing, Type 1 Diabetes, Rural Healthcare, Continuous Glucose Monitoring, Home Care, Patient Education, HbA1C

Background:

In rural areas, access to specialized diabetes care remains limited, despite Sweden’s tradition of diabetes-specialized nursing since the 1970s. Existing research highlights the potential of telehealth and mobile nursing, but further evidence is needed to assess their feasibility and impact. This study provides new insights into how digital consultations and mobile diabetes nursing can enhance care delivery in rural settings.

Research questions:

Can telehealth and mobile diabetes nursing improve diabetes management and patient satisfaction in rural settings while maintaining clinical outcomes?

Method:

This pilot study included two sub-projects. Digital Diabetes Contacts involved a diabetes nurse conducting repeated video consultations with 13 type 1 diabetes patients (aged 25–72) using continuous glucose monitoring and insulin pumps. Four PROMs were collected, and semistructured interviews were conducted pre- and post-intervention. Mobile Diabetes Nurse involved training home care nurses to support 19 elderly patients (aged 75–90) with type 1 diabetes through peer mentoring and joint patient visits, including virtual sessions. Outcomes included changes in HbA1c, time-in-range, and qualitative insights from interviews.

Results:

Preliminary results showed stable HbA1c and time-in-range metrics from baseline to follow-up, despite influencing factors such as mental health issues and pump failures. Patients appreciated reduced travel time, cost savings, and environmental benefits, although survey fatigue was noted. Home care nurses reported increased competence and confidence in diabetes management.

Conclusions:

Telehealth and mobile diabetes nursing are feasible and acceptable strategies for enhancing care delivery in rural Sweden. These interventions can improve patient satisfaction while maintaining clinical outcomes. The findings will inform the design of a randomized controlled trial and further refinement of the Mobile Diabetes Nurse model, with potential for broader applicability in similar rural contexts.

Points for discussion:

How can telehealth ensure high-quality diabetes management in rural settings?

What are the challenges of integrating mobile diabetes nursing for elderly patients?

How can these findings shape the scalability of future interventions?

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