JMIR Publications

ABSTRACT

Background:

Mobile-based interventions appear to be promising in ameliorating huge burdens of type 2 diabetes. However, it is unclear how effective the mobile-based interventions are in glycemic management of patients with type 2 diabetes based on real-world evidence.

Objective:

This study aimed to evaluate the effectiveness of a mobile-based intervention on glycemic control in patients with type 2 diabetes based on real-world population data.

Methods:

This retrospective propensity score-matched cohort study analyzed longitudinal data from the clinical electronic health database. The study population included 37913 patients with type 2 diabetes at cohort entry between October 1, 2016, and July 31, 2018. A total of 2400 patients were propensity score-matched 1:1 into the usual care and mobile health (mHealth) groups. The primary outcomes of glycemic control included control rates of glycated hemoglobin A1c (HbA1c), fasting blood glucose (FBG), and postprandial 2-hour blood glucose (P2BG). Mean and variation trends of difference with 95% CI were secondary outcomes. General linear model was used to calculate repeated measures ANOVAs to examine the differences of two groups. Subgroup and sensitivity analyses were performed.

Results:

Of the 2400 patients included in the analysis, 1440 (60%) were male; mean (SD) age was 52.24 (11.56) years. At baseline, the control rates of HbA1c, FBG, and P2BG in mHealth and usual care groups were 45.75% vs. 47.00% (P=.567), 38.03% vs. 32.76% (P=.066), and 47.32% vs. 47.89% (P=.830), respectively. At the 3-, 6-, 9-, and 12-month follow-ups, the mHealth group reported higher control rates of HbA1c than usual care group, which were 69.97% vs. 46.06% (P＜.001), 71.89% vs. 61.24% (P=.004), 75.38% vs. 53.44% (P＜.001), and 72.31% vs. 46.70% (P＜.001), respectively; the control rates of FBG in mHealth and usual care groups were statistically different, which were 59.24% vs. 34.21% (P＜.001), 56.61% vs. 35.14% (P＜.001), 59.54% vs. 34.99% (P＜.001), and 59.77% vs. 32.83% (P＜.001), respectively; the control rates of P2BG in mHealth group were statistically higher than usual care group, which 79.72% vs. 48.75% (P＜.001), 80.20% vs. 57.45% (P＜.001), 81.97% vs. 54.07% (P＜.001), and 76.19% vs. 54.21% (P=.001), respectively. The percentages of HbA1c reduction in mHealth group were 8.66% (95% CI 6.69-10.63), 10.60% (95% CI 8.66-12.54), 10.64% (95% CI 8.70-12.58), and 8.11% (95% CI 6.08-10.14), respectively; the percentages of P2BG reduction in mHealth group were 8.44% (95% CI 7.41-10.73), 17.77% (95% CI 14.98-20.23), 16.23% (95% CI 13.05-19.35), and 16.91% (95% CI 13.17-19.84), respectively. Starting from the sixth month, the mean HbA1c and P2BG values in two groups increased slightly.

Conclusions:

This mobile-based intervention delivered by a multidisciplinary team can better improve glycemic control rates of patients with type 2 diabetes compared with usual care. These effects were best sustained within the first six months. Starting from the sixth month, intensive management need be conducted to maintain long-term effectiveness of the mobile-based intervention.