Diabetes Management Through Remote Patient Monitoring: A Mixed-Methods Evaluation of Program Enrollment and Attrition

<b>Background:</b> Despite the growing use of remote patient monitoring (RPM) in diabetes management, few studies have assessed program enrollment and attrition. This study adopted a mixed-methods approach to examining factors linked to program enrollment and attrition amongst a large sample of patients who went through RPM in diabetes management. <b>Methods:</b> Based on quantitative data from the Remote Interventions Improving Specialty Complex Care program conducted in Nebraska from 2014 to 2018, chi-squared or <i>t</i> tests were used to compare three groups of patients with diabetes who had been contacted for program participation: those who completed the intervention, withdrew from the intervention, or declined to participate. Logistic regression was used to identify factors associated with program dropout. Inductive thematic analysis was conducted to assess patient feedback based on semi-structured interviews with patients from the three groups. <b>Results:</b> Out of the 1993 patients with diabetes invited for participation, 13% (n = 256) declined to participate, 16% (n = 317) withdrew before completion, and 71% (n = 1420) completed the intervention. Being younger or having poorer health (as indicated by higher blood glucose or blood pressure) at the baseline was associated with higher odds of program withdrawal. The top reason patients cited for declining participation or withdrawal from RPM was not having enough time to complete the intervention. Patients who declined to participate mentioned that an offer of incentives or more information at the beginning of the intervention may increase their motivation for participation. <b>Conclusions:</b> Being younger or having poorer health at the baseline was associated with higher odds of withdrawing from the RPM program. Future RPM programs can increase program retention by becoming more responsive to the health needs of vulnerable patients who struggle with managing their diabetes or related comorbidities at the baseline.