Abstract
Background The aim of this study was to assess the benefits of a mobile-enabled app through Lilly Connected Care Program (LCCP) in achieving blood glucose control and adhering to self-monitoring of blood glucose in patients with type 2 diabetes mellitus (T2DM). Methods This retrospective study included T2DM patients who were initiated on insulin therapy (mostly premixed insulin) after failure to respond to oral antidiabetic drugs. Patients were provided with glucometers enabled with synchronous data transmission to healthcare providers and family members. The primary objective was to assess the benefits of LCCP based on changes in fasting blood glucose (FBG) and postprandial glucose (PPG) levels from baseline to 12 weeks. Paired t-test was used to assess the change in blood glucose (BG) from baseline to week 12. Results In total, 14,085 T2DM patients were recruited. Compared with baseline, significant reductions in FBG and PPG were evident at week 12 (FBG: -0.39 mmol/L; PPG: −0.79 mmol/L; both P < 0.001). Furthermore, at week 12, the proportion of patients attaining a target glucose level of FBG <7.0 mmol/L and PPG <10.0 mmol/L was 25.37% and 59.68%, respectively, with a statistically significant increase compared with that at baseline (6.74% and 45.59%, respectively, both P < 0.001). The frequent monitoring of patients could gain a higher target achievement of FBG (28.1% vs 24.2%) and PPG (64.4% vs 55.1%) than the occasional monitoring patients. Additionally, the incidence of hypoglycemia gradually decreased and was significantly lower than the baseline level. Conclusions In T2DM patients with poor glycemic control, the application of mobile enabled intervention (LCCP) along with insulin significantly reduced the hypoglycemia while improving glycemic control during period of naïve initiating insulin therapy. Additionally, the high frequency of BG self-monitoring was associated with better glycemic control.
Highlights
Diabetes mellitus is a chronic metabolic disorder that has quadrupled in the past three decades and has emerged as a global pandemic associated with substantial socioeconomic burden [1]. e disease is characterized by dysfunction of the glucoregulatory system leading to abnormally elevated hyperglycemia and dysregulation of carbohydrate, protein, and lipid metabolism [2, 3]
According to the American Diabetes Association (ADA), diabetes self-management should be patient-centered and is usually recommended to be given individually or in groups or using technology [6]
The patients were rewarded with credits for blood glucose (BG) monitoring, diabetes knowledge quiz, and updated antidiabetic regimens. e patient support system consisting of e-courses offered guidance for BG monitoring, dietary advice, and systematic reminder for reinforcing compliance based on the individual BG levels. e courses in the platform were developed on the basis of standards of medical care for type 2 diabetes in China [17] and the self-care courses were based on the American Association of Diabetes Educators 7 Standard of Care [18]
Summary
Diabetes mellitus is a chronic metabolic disorder that has quadrupled in the past three decades and has emerged as a global pandemic associated with substantial socioeconomic burden [1]. e disease is characterized by dysfunction of the glucoregulatory system leading to abnormally elevated hyperglycemia and dysregulation of carbohydrate, protein, and lipid metabolism [2, 3]. E 2019 treatment guidelines for diabetes published by the American Diabetes Association (ADA) recommend collaborative, multifactorial therapies for improving the long-term outcomes of the disease [6]. The ADA recommends all diabetic patients to attend self-management educational programs to enable the knowledge, skills, and ability required for diabetes self-care in order to International Journal of Endocrinology achieve an optimal glycemic control [6, 7]. According to the ADA, diabetes self-management should be patient-centered and is usually recommended to be given individually or in groups or using technology [6]. There is not enough knowledge regarding self-management and treatment adherence in Chinese patients with diabetes, and this has been challenging for general practitioners in China [8]. Self-management of diabetes includes dietary monitoring, being physically active, self-monitoring of blood glucose (BG) (SMBG) levels, treatment compliance, healthy coping skills, and adjustments in mental status [9, 10]
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