SAT-LB120 A Software Application Delivering Behavioral Therapy Improved Glycemic Control in Adults With Type 2 Diabetes

Abstract

Despite advances in pharmacological treatment, half of U.S. patients with type 2 diabetes are not achieving glycemic control (1). Even when glycemic control is achieved via pharmacotherapy, a substantial residual risk to all-cause mortality still exists (2). An overlooked contributor to both poor glycemic control and mortality risk is the need to address the behavioral determinants of type 2 diabetes. We tested a novel software application (app) designed to change behaviors that are root causes of type 2 diabetes and improve glycemic control. If behavioral therapy is effective and can be delivered using software installed on a patient’s smartphone, it may provide a cost-effective means of improving outcomes in this patient population. To study this hypothesis, we examined data from app users with suboptimal glycemic control, as defined by having a 3-day average of self-reported fasting blood glucose (FBG) values ≥ 152 mg/dL, who used the app for 12 weeks. 74 participants residing in 32 U.S. states met inclusion criteria. Their baseline characteristics (means±SD) were an age of 55.2±7.0 years, body mass index 34.7±7.9 kg/m2, 71.6% (53/74) female, current use of 2.2±0.9 antihyperglycemic medications, FBG 199.4±45.1 mg/dL and 10.6±7.1 years since diagnosis of type 2 diabetes. Change in FBG was calculated as the difference between 3-day averages anchored by the first and last values reported. Mean change in FBG was -22.9±42.0 mg/dL (P=0.001, using paired t-test) with an average of 69.0±29.9 days between the first and last value reported. Participants reported an average of 4.4±1.7 FBG values each week over 12-weeks. Participants used the app on average 4.6±1.8 days each week and spent 5.6±8.3 minutes each use. We performed a tertile analysis to examine the relationship between degree of behavioral therapy use and change in glycemic status. The mean changes in FBG in the lowest to highest tertile of behavioral therapy use were -14.4±39.2, -20.4±47.6 and -32.9±38.4 mg/dL (P=0.06, comparing lowest to highest tertile, using a pairwise comparison of the least squares means accounting for baseline FBG and years since diagnosis). These results suggest use of this novel software application is associated with meaningful improvements in glycemic control in a widely distributed treatment population and warrants further study.Refs: (1) Edelman et al., Diabetes Care 2017 Nov; 40(11): 1425-1432. (2) Rodríguez-Gutiérrez et al., Circ Cardiovasc Qual Outcomes. 2016; 9:504-512.