TOPLINE

A nurse-led digital therapeutics pathway was associated with higher adherence, greater reductions in A1c, and favorable patient-reported outcomes than usual care among adults with type 2 diabetes over 24 weeks.

METHODOLOGY

• Researchers conducted a retrospective observational cohort study of adults with type 2 diabetes, using de-identified electronic health records from the endocrinology department of a tertiary hospital over 24 weeks. 
• Overall, 120 eligible patients were classified according to their documented routine-care pathway: nurse-led digital therapeutics pathway (n = 60) or usual care (n = 60); 113 patients had complete 24-week outcomes. Baseline characteristics were broadly similar between the groups.
• The nurse-led pathway included digital readiness assessment, onboarding education, adherence monitoring through a backend dashboard, tiered follow-up, personalized feedback reports, and coordination among nurses, physicians, patients, and technical staff. Usual care included brief guidance on downloading the same mobile application, a printed user manual, and routine outpatient visits. 
• The primary outcomes were digital therapeutics adherence (defined as the proportion of prescribed days with documented application use over 168 days) and glycated hemoglobin change from baseline to week 24. 
• The secondary outcomes included patient satisfaction (assessed by 18-item Patient Satisfaction Questionnaire [PSQ-18]), self-management behavior (by Summary of Diabetes Self-Care Activities [SDSCA]), glycemic variability, and documented nursing workload.

TAKEAWAY

• Digital therapeutics adherence was 78.3% with the nurse-led pathway vs 54.7% with usual care (difference, 23.6 percentage points; P < .001); sensitivity analysis using entropy balancing showed similar results.
• Mean change in A1c was −0.8% with the nurse-led pathway vs −0.3% with usual care, a difference of −0.5 percentage points (P < .001); 78.9% vs 30.4% of patients, respectively, achieved a clinically meaningful reduction of at least 0.5%.
• PSQ-18 satisfaction scores were higher (80.3 vs 68.5; difference, 11.8 points; P < .001), SDSCA scores improved (+1.8 vs +0.6; difference, 1.2 points; P < .001), and glucose coefficient of variation decreased (−8.7% vs −3.6%; difference, −5.1 percentage points; P < .001) with the nurse-led pathway.
• Nurses spent an average of 3.5 hours per week on the nurse-led pathway, including 1.2 hours for health education, 0.8 hours for patient assessment, 0.7 hours for adherence monitoring, 0.5 hours for outcome feedback, and 0.3 hours for multi-party coordination.

IN PRACTICE

"These observations do not establish causality, but they support the clinical plausibility of linking digital tools with readiness assessment, patient education, adherence monitoring, feedback, safety escalation, and continuity of care," the authors wrote.

SOURCE

The study was led by Jinyan Ma, Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China. It was published online on August 12, 2026, in Frontiers in Public Health.

LIMITATIONS

The single-center, retrospective design limited causal conclusions and generalizability. Because patients were classified by documented pathway exposure, unmeasured differences between groups may have influenced results. The relatively small outcome sample precluded subgroup comparisons. Additionally, data on medication changes, insulin use, comorbidities, lifestyle factors, and digital access barriers were incomplete.

DISCLOSURES

The study received no financial support, and the authors reported no potential conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.