Abstract
BackgroundThe efficacy of digital technology in improving diabetes management has typically been demonstrated through studies such as randomized controlled trials, which have reported a steeper reduction in hemoglobin A1c (HbA1c) values for patients who adopted a digital solution. However, evidence from real-world clinical practice is still limited.ObjectiveThis study aimed to evaluate the effectiveness of digital interventions by tracking HbA1c improvements over 1 year in real-world clinical settings.MethodsPatients used the Health2Sync mobile app to track self-measured outcomes and communicate with health care professionals (HCPs). HCPs used the web-based Patient Management Platform to monitor patient data, view test results from clinical laboratories, and communicate with patients. Patients who have been onboarded for at least 13 months and have consecutive HbA1c findings for 5 quarters were included in the analysis. They were then stratified into 3 groups (high, mid, and low retention) based on their level of use of Health2Sync in the first 6 months of onboarding. A mixed model was built to compare the slopes of the rate of reduction in HbA1c among the groups. In addition, these patients’ retention on the app from the seventh to the 12th month was verified through multiple comparisons.ResultsA sample of 2036 users was included in the analysis. With the mixed model coefficient estimates, we found that app users had significant HbA1c percentage reductions as the passed quarter count increased (t=–9.869; P<.001), and that effectiveness increased in the high (t=–5.173) and mid retention (t=–6.620) groups as the interaction effects were significantly negative compared to that in the low retention group (P<.001) in the passed quarter count. The low retention group also had the highest average HbA1c value at the end of 13 months (high: 7.01%, SD 1.02%; mid: 6.99%, SD 1.00%; low: 7.17%, SD 1.14%) (Bonferroni correction: high vs low, P=.07; mid vs low, P=.02; high vs mid, P>.99). The level of use of the app remained consistent in the seventh to the 12th month after onboarding (high: 5.23 [SD 1.37] months, mid: 2.43 [SD 1.68] months, low: 0.41 [SD 0.97] months) (P<.001).ConclusionsOur analysis shows that continuous usage of the diabetes management app is associated with better glycemic control in real-world clinical practice. Further studies are required to reveal the efficacy for specific diabetes types and to observe effects beyond 1 year.
Highlights
Global diabetes prevalence in the adult population is estimated to have grown from 8.5% in 2014 to 9.3% in 2019 and is projected to be over 10% by 2030 [1,2]
Our analysis shows that continuous usage of the diabetes management app is associated with better glycemic control in real-world clinical practice
We evaluated the difference in hemoglobin A1c (HbA1c) improvement between active app users and those who drop out from the app in a real-world context, and monitored their glycemic control status for 1 year
Summary
Global diabetes prevalence in the adult population is estimated to have grown from 8.5% in 2014 to 9.3% in 2019 and is projected to be over 10% by 2030 [1,2]. Multiple meta-analyses on randomized controlled trials (RCTs) have shown that interventions including mobile apps help patients, especially those with type 2 diabetes, to lower their HbA1c levels significantly without notable adverse effects [8,9,10,11,12,13,14]. These apps usually allow patients with diabetes to log and visualize their self-monitored data, provide education and feedback, or provide communication channels between patients and their caregivers or peers [12,13,15]. Evidence from real-world clinical practice is still limited
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