Abstract
Rural older adults living with type 2 diabetes mellitus face substantial barriers to accessing specialized healthcare, leading to sub-optimal glycemic control and poor self-management outcomes. This randomized controlled trial evaluated the effectiveness of a 24-week Nurse-Led Telehealth Supervision Protocol (NLTSP) on glycemic control (HbA1c) and self-care behaviors among rural older adults. A total of 140 participants aged 65 years and older were randomly assigned to either the NLTSP intervention group (n = 70) or the standard care control group (n = 70). The intervention comprised bi-weekly structured video consultations with registered nurses, cellular-enabled remote patient monitoring of blood glucose levels, and personalized self-care education focused on diet, medication adherence, and foot care. The primary outcome was change in baseline HbA1c at 24 weeks; secondary outcomes included changes in Summary of Diabetes Self-Care Activities (SDSCA) scores. At 24 weeks, the intervention group demonstrated a statistically significant reduction in mean HbA1c compared to the control group (-1.24% vs. -0.21%, p < 0.001). Furthermore, the NLTSP group exhibited significant improvements in overall self-care behaviors (p < 0.001), specifically in glucose monitoring and dietary compliance. Nurse-led telehealth supervision represents a scalable, highly effective strategy for closing care delivery gaps, enhancing chronic disease self-management, and improving health outcomes among geographically isolated older populations.
