The effect of remote nurse-led patient education and follow-up on glycemic control and metabolic function in patients with type 2 diabetes: a single-blind randomized controlled trial

Type 2 Diabetes (T2D) is a chronic metabolic disorder characterized by impaired insulin secretion, insulin resistance, and progressive β-cell dysfunction that ultimately leads to serious vascular and metabolic complications. Effective diabetes management requires innovative approaches such as remote education and nurse-led interventions. Therefore, this study aimed to investigate the effect of remote nurse-led patient education and follow-up on glycemic control and key metabolic functions including pancreatic β-cell function (HOMA-β), insulin sensitivity (HOMA-α), and insulin resistance (HOMA-IR) in T2D patients. This is a single-blind randomized controlled trial conducted on a total of 66 patients with T2D. Participants were randomly assigned to the intervention (n = 33) and control (n = 33) groups. The intervention group received three months of daily remote education via text, audio, and video messages combined with weekly follow-ups. Baseline and post-intervention data included Fasting Blood Glucose (FBG), fasting insulin, glycosylated hemoglobin (HbA1c), and HOMA indices. Data were analyzed using IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, N.Y., USA). Significant within-group improvements were observed in the intervention group for FBG, HbA1c, HOMA-β, HOMA-α, and HOMA-IR scores (p < 0.05); however, the control group showed no significant within-group changes (p > 0.05). Between-group analysis showed greater improvements in the intervention group compared to the control group for all above outcomes (p < 0.05). In this randomized trial, a three-month remote nurse-led patient education and follow-up program was associated with improvements in several glycemic and metabolic markers, including FBG, HbA1c, HOMA-IR, HOMA-α, and HOMA-β, compared with usual care. These preliminary findings suggest potential metabolic benefits and highlight the need for larger, longer-term studies to confirm these effects before broader clinical application. This study was prospectively registered in the Iranian Registry of Clinical Trials on 15 July 2024 (IRCT20240708062366N1, https://irct.behdasht.gov.ir/trial/77809). After trial registration, participant recruitment began on 1 August 2024 and continued until 1 October 2024. Remote nurse-led patient education and follow-up was associated with better glycemic control and pancreatic β-cell function (HOMA-β), insulin sensitivity (HOMA-α), and insulin resistance (HOMA-IR) in type 2 diabetes. The intervention group exhibited favorable changes in HbA1c, fasting blood glucose, HOMA-IR, HOMA-β, and HOMA-α. Findings suggest possible links between remote education and glycemic and metabolic indices. Larger and long-term trials are needed to confirm these findings. Remote nurse-led interventions are associated with improved glycemic control, as demonstrated by reduced HbA1c levels in patients with type 2 diabetes. Digital health interventions are related to improved patient adherence and self-care behaviors in type 2 diabetes. However, evidence regarding their effects on HOMA-β and HOMA-α remains limited and underexplored. Remote nurse-led patient education was linked to favorable changes in key metabolic indices (HOMA-β, HOMA-α, HOMA-IR) at three months. Beyond HbA1c reduction, tele-nursing interventions were associated with changes in metabolic indices in type 2 diabetes.