Type 2 Diabetes Comprehensive Care 'App' 'Improves Control'

A smartphone-based application for patient-centered diabetes care and management that incorporates diet, exercise, and social networking alongside glucose monitoring significantly improves type 2 diabetes control, suggest Korean research findings.

Young Min Cho, MD, PhD, Department of Internal Medicine, Seoul National University College of Medicine, South Korea, and colleagues developed a mobile healthcare platform with an individualized diabetes management algorithm, as well as many others features typically not seen in other systems.

The research, published online in Diabetes Care, shows that, compared with a paper logbook, their diabetes care platform significantly improved HbA_1c levels.

In addition, the system was associated with significantly more reductions in HbA_1c below the 7.0% threshold compared with paper logging, crucially without patients experiencing hypoglycemia.

The team also points out that patients assigned to the diabetes care platform experienced an increase in perceived overall quality of life over the course of the study.

They write that, taken together, the findings show that the platform "is an efficacious and safe tool, which may improve daily management of type 2 diabetes."

Twice as Many Patients Reached HbA_1c < 7% With mDiabetes

In recent years, tens of thousands of mobile healthcare applications or "apps" have been developed, with many designed to help patients manage type 2 diabetes.

Indeed, a meta-analysis of such apps indicates that their use is associated with an average HbA_1c reduction of –0.4% (PLoS One. 2016;11:e0166718).

However, the South Korean researchers point out that varied aspects of type 2 diabetes management, such as diet, physical activity, glucose monitoring, insulin titration, and social networking, are not commonly included on a single platform.

They initially developed a smartphone-based, patient-centered diabetes care system with a range of interactive components. This was shown in a pilot study to be associated not only with reductions from baseline in HbA_1c of 0.6% but also improvements in self-management, such as diet and exercise (Diabetes Metab J. 2016;40:192-201).

For the current study, the team upgraded the user interface and insulin dose adjustment algorithm for their platform, renamed mDiabetes, as well as modifying some of the clinical decision-support systems.

They recruited patients with type 2 diabetes from three teaching hospitals aged 19 to 80 years who had HbA_1c levels between 7.0% and 10.0% and stable control of their diabetes.

After a 2-week run-in, during which the patients had to show > 80% compliance with completing a daily blood glucose logbook, they were randomized 1:1 to the mDiabetes platform or a paper logbook.

Participants in the mDiabetes group were also provided with an activity tracker and instructed on how to use the app and connect with both the tracker and a bluetooth glucometer provided to both groups.

In all, 191 patients were assigned to the mDiabetes or logbook groups, with complete data available for 172 patients, of whom 90 were in the mDiabetes group and 82 in the logbook group.

Patients assigned to mDiabetes were significantly older than those in the logbook group, at 60.0 years versus 56.7 years (P = .027), but otherwise, baseline characteristics were well balanced between the groups.

After 24 weeks, the mDiabetes group had a greater mean reduction in HbA_1c levels from baseline than those in the logbook group, at 0.40% versus 0.06%, or a difference in adjusted mean change of 0.35% (P = .001).

Patients in the mDiabetes group were also twice as likely to experience a drop in HbA_1c levels below 7.0% than the logbook group, at 41.1% versus 20.7%, or an odds ratio of 2.01 (P = .003).

The proportion of patients who experienced such a drop but without experiencing hypoglycemia was also greater with the mDiabetes platform than the logbook, at 31.1% versus 17.1%, at an odds ratio of 1.82 (P = .024).

The two groups had comparable weight loss over the study, although the mDiabetes group showed a greater reduction in percentage body fat.

Neither group showed significant changes in blood pressure or lipid profile from baseline.

There was no significant difference between the mDiabetes and logbook groups in terms of the proportion of patients who experienced severe hyperglycemia (32.3% vs 33.7%; P = .948) or hypoglycemia (28.0% versus 29.3%; P = .857) during follow-up.

Patients in the mDiabetes group also experienced an increase in quality of life scores on the World Health Organization Quality of Life scale, abbreviated version, at week 24 versus baseline, with scores increasing from 44.0 to 50.6 (P = .0008).

In conclusion, say the authors, "The implementation of the mDiabetes for patients with inadequately controlled type 2 diabetes resulted in a significant reduction in HbA_1c levels, with tolerable safety profiles."

This study was funded by HealthConnect Co. The authors have reported no relevant financial relationships.

Diabetes Care. Published online October 30, 2018. Abstract

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