Abstract
BackgroundDiabetes is present in 10.5% of the US population and accounts for 14.3% of all office-based physician visits made by adults. Despite this established office-based approach, the disease and its adverse outcomes including glycemic control and clinical events tend to worsen over time. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record.ObjectiveThis study aims to evaluate the impact of a virtual, home-based diabetes management program on clinical measures of diabetes control compared to usual care.MethodsWe evaluated glycemic control and other diabetes-related measures after 1 year in 763 patients with type 2 diabetes enrolled into a home-based digital medicine diabetes program and compared them to 794 patients matched for age, sex, race, BMI, hemoglobin A1c (HbA1c), creatinine, estimated glomerular filtration rate, and insulin use in a usual care group after 1 year. Digital medicine patients completed questionnaires online, received medication management and lifestyle recommendations from a clinical pharmacist or advanced practice provider and a health coach, and were asked to submit blood glucose readings using a commercially available Bluetooth-enabled glucose meter that transmitted data directly to the electronic medical record.ResultsAfter 1 year, usual care patients demonstrated no significant changes in HbA1c (mean 7.3, SE 1.7 to mean 7.3, SE 1.6; P=.41) or changes in the proportion of patients with HbA1c≥9.0 (n=117, 15% to n=113, 14%; P=.51). Digital medicine patients demonstrated improvements in HbA1c (mean 7.3, SE 1.5 to mean 6.9, SE 1.2; P<.001) and significant changes in the proportion of patients with HbA1c≥9.0 (n=107, 14% to n=49, 6%; P<.001), diabetes distress (n=198, 26% to n=122, 16%; P<.001), and hypoglycemic episodes (n=313, 41.1% to n=91, 11.9%; P<.001).ConclusionsA digital diabetes program is associated with significant improvement in glycemic control and other diabetes measures. The use of a virtual health intervention using connected devices was widely accepted across a broad range of ethnic diversity, ages, and levels of health literacy.
Highlights
The confluence of population trends, poor health outcomes, and rising costs of care make diabetes management a high global priority for health care [1]
Prior to enrollment in the digital diabetes program, patients were under the care of their primary care clinician for their diabetes for an average of 5.2 years, averaging 2.8 visits per year
The digital health monitoring and intervention program significantly improved hemoglobin A1c (HbA1c) levels, attainment of goal HbA1c, lipid levels, diabetes distress, and annual health maintenance adherence compared to usual care
Summary
The confluence of population trends, poor health outcomes, and rising costs of care make diabetes management a high global priority for health care [1]. Progress has been made to improve risk factors for microvascular and macrovascular disease in diabetes, approximately half of individuals with diabetes do not meet individualized targets for HbA1c, and less than 15% meet all three targets of glycemic control, blood pressure, and low-density lipoprotein (LDL) cholesterol [8,9,10] Outcomes such as emergency department visits, lower extremity amputations, hospitalizations for hyperglycemic crisis, and deaths due to diabetes have worsened over the past decade [10,11]. Methods: We evaluated glycemic control and other diabetes-related measures after 1 year in 763 patients with type 2 diabetes enrolled into a home-based digital medicine diabetes program and compared them to 794 patients matched for age, sex, race, BMI, hemoglobin A1c (HbA1c), creatinine, estimated glomerular filtration rate, and insulin use in a usual care group after 1 year. The use of a virtual health intervention using connected devices was widely accepted across a broad range of ethnic diversity, ages, and levels of health literacy
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