Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Aug 14, 2018
Date Accepted: Feb 17, 2019
(closed for review but you can still tweet)
Impact of Use Frequency of a Mobile Diabetes Management App on Blood Glucose Control
ABSTRACT
Background:
Technology has long been used to carry out self-management as well as improve adherence to treatment of diabetic patients. However, most technology-based applications (apps) do not meet the basic requirements for engaging patients.
Objective:
To evaluate the effect of use frequency of a diabetes management app on glycemic control and analyze the role of app engagement through self-efficacy and personal empowerment.
Methods:
Two studies were performed. The first analyzed the reduction of blood glucose (BG) mean and the respective HbA1c, using a randomly selected group of 211 users of the SocialDiabetes app, among which 68.2% (144/211) had type 1 diabetes (T1D) and 31.8% (67/211) had type 2 diabetes (T2D). BG levels at baseline, month 3, and month 6 were calculated using the intercept of a regression model based on data from months 1, 4, and 7, respectively. The second study examined the impact of low and high BG risk. A total of 2692 users of the SocialDiabetes app were analyzed, among which 83.5% (2248/2692) had T1D and 16.5% (444/2692) had T2D. From each group, the highest quartile regarding low and high BG indices (LBGI and HBGI) at baseline (t1) was selected (n=74 for group A, n=440 for group B). Changes in HBGI and LBGI at month 6 (t2) were analyzed. Inclusion criteria: engagement (logging ≥5 days/month for ≥6 months).
Results:
For study 1, baseline BG-results for T1D groups A and B were 213.61 (SD=31.57) mg/dL and 206.43 (SD=18.65) mg/dL, respectively, which decreased at month 6 to 175.15 (SD=37.88) mg/dL and 180.6 (SD=40.47) mg/dL, respectively. For T2D, baseline BG was 218.77 (SD=40.18) mg/dL and 232.55 (SD=46.78) mg/dL, respectively, which decreased at month 6 to 160.51 (SD=39.32) mg/dL and 173.14 (SD=52.81) mg/dL for groups A and B, respectively. This represents a reduction of eA1c of approximately 1.3% (P<.001) and 0.9% (P=.001) for T1D groups A and B, respectively, and 2% (P<.001) for both A and B T2D groups, respectively. For study 2, T1D baseline LBGI results for groups A and B were 5.2 (SD=3.9) and 4.4 (SD=2.3), respectively, which decreased at t2 to 3.4 (SD=3.3) and 3.4 (SD=1.9), respectively; this was a reduction of 39% (P=.005) and 22% (P=.02), respectively, in the mean. Baseline HBGI results for groups A and B were 12.6 (SD=4.3) and 10.6 (SD=4.03), respectively, which decreased at t2 to 9.0 (SD=6.5) and 8.6 (SD=4.7), respectively; this was a reduction of 30% (P=.001) and 22% (P=.003), respectively, in the mean.
Conclusions:
A significant reduction in BG was found in all groups, independent of the use frequency of the app. Better outcomes were found for T2D patients. A significant reduction in LBGI and HBGI was found in all groups, regardless of the use frequency of the app. LBGI and HBGI indices of both groups tend to have similar values after 6 months of app use.
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