Telemedicine-Based Behavioral Intervention to Improve Outcomes Among Diabetic Patients

Diabetic management outcome

Glycemic control will be assessed using glycated hemoglobin (HbA1c), which reflects average blood glucose levels over the preceding 2-3 months. HbA1c will be measured through standardized laboratory testing using venous blood samples collected at baseline and at the end of the three-month intervention period. Samples will be analyzed in accredited hospital laboratories using standardized assay methods. Glycemic control will be evaluated by comparing HbA1c levels before and after the intervention. A reduction in HbA1c indicates improved glycemic control. Participants achieving an HbA1c level of \<7% will be classified as having good glycemic control, in accordance with standard clinical guidelines.

Medication Adherence

Medication adherence will be measured using the Hill-Bone Medication Adherence Scale adapted for diabetes management, which assesses behaviors related to taking prescribed antidiabetic medications. The scale evaluates the frequency of missed doses, timing adherence, and correct dosing over the past seven days. Scores will be calculated according to standardized Hill-Bone criteria, with higher scores indicating better adherence. Medication adherence will be classified as good if all prescribed doses are taken on all seven days, and poor if any dose is missed.

Hospital Admission

Hospital admission due to diabetes-related complications will be assessed using a self-report question: "Have you been admitted to a hospital in the past one month due to diabetes or its complications?" Responses will be coded as 1 = Yes and 2 = No. This outcome will be analyzed as a binary variable, with "Yes" indicating an admission and "No" indicating no admission. The measure will be collected at baseline and at the end of the intervention period to evaluate recent hospitalization related to diabetes.

Diabetes Self-Care Practice

Diabetes self-care practice will be measured using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire, a validated instrument that assesses adherence to key diabetes self-management behaviors. The SDSCA evaluates the frequency of self-care activities performed over the past seven days across multiple domains, including general diet, specific diet, physical activity, blood glucose testing, foot care, and medication adherence. Each item is scored based on the number of days (0-7) the activity was performed during the previous week. Domain scores will be calculated according to standardized SDSCA guidelines, and higher scores indicate better self-care practice. Overall self-care practice will be classified as good if participants achieve at least 70% of the recommended behaviors across domains, and poor if they score below this threshold.

Diabetes Knowledge Score

Diabetes knowledge will be measured using the Diabetes Knowledge Questionnaire (DKQ-24), a validated instrument designed to assess patients' understanding of diabetes and its management. The questionnaire consists of 24 items covering key areas, including disease etiology, symptoms, treatment, medication use, diet, physical activity, blood glucose monitoring, and prevention of complications. Each item is scored as correct or incorrect according to standardized DKQ-24 scoring guidelines. The total knowledge score ranges from 0 to 24, with higher scores indicating better diabetes-related knowledge. Participants scoring ≥70% of correct responses will be classified as having good diabetes knowledge, while those scoring below this threshold will be classified as having poor knowledge.