Open AccessThe Effects of Continuous Usage of a Diabetes Management App on Glycemic Control in Real-world Clinical Practice: Retrospective Analysis
Author(s) -
Yu Zhen Tu,
Ya-Ting Chang,
Hung Yi Chiou,
Ken Lai
Publication year - 2021
Publication title -
jmir. journal of medical internet research/journal of medical internet research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.446
H-Index - 142
eISSN - 1439-4456
pISSN - 1438-8871
DOI - 10.2196/23227
Subject(s) - glycemic , medicine , onboarding , psychological intervention , mhealth , randomized controlled trial , diabetes management , telemedicine , diabetes mellitus , digital health , physical therapy , health care , type 2 diabetes , psychology , nursing , social psychology , economic growth , economics , endocrinology
Background The 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 A 1c (HbA 1c ) values for patients who adopted a digital solution. However, evidence from real-world clinical practice is still limited. Objective This study aimed to evaluate the effectiveness of digital interventions by tracking HbA 1c improvements over 1 year in real-world clinical settings. Methods Patients 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 HbA 1c 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 HbA 1c among the groups. In addition, these patients’ retention on the app from the seventh to the 12th month was verified through multiple comparisons. Results A sample of 2036 users was included in the analysis. With the mixed model coefficient estimates, we found that app users had significant HbA 1c 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 HbA 1c 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). Conclusions Our 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.