Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 13, 2019
Date Accepted: Jan 27, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effectiveness of Lilly Connected Care Program® (LCCP®) App-Based Diabetes Education for Type 2 Diabetic Patients Treated with Insulin: A Retrospective Real-World Study
ABSTRACT
Background:
Diabetes poses a heavy economic and social burden worldwide. Mobile apps show great potential for diabetes self-management education. However, there is limited evidence for the effectiveness of providing general diabetes education through mobile apps.
Objective:
The aim of this study was to clarify the effectiveness of the Lilly Connected Care Program® (LCCP®) app-based diabetes education for glycemic control.
Methods:
This retrospective cohort study included diabetic patients recruited to the LCCP platform from September 1, 2018, to May 31, 2019. Each patient was followed up for 12 weeks. According to the number of diabetes education courses they had completed, the patients were divided into three groups: group A (0-4 courses), group B (5-29 courses) and group C (≥30 courses). The main outcomes were the change in blood glucose at the 12th week compared with baseline and the differences in blood glucose at the 12th week among the three groups. The association between the number of diabetes education courses completed and the average blood glucose and self-monitoring of blood glucose (SMBG) at the 12th week was assessed by multivariate linear regression analysis controlling for other confounding covariates. Univariate and multivariate linear regression analyses were used to assess the factors influencing patients’ engagement in the diabetes education courses.
Results:
A total of 5011 participants were enrolled. Their mean fasting blood glucose (FBG) and postprandial blood glucose (PBG) were significantly lower at the 12th week than at baseline (FBG, 7.46 ± 1.95 vs 7.79 ± 2.18 mmol/L, P <.001; PBG, 8.94 ± 2.74 vs 9.53 ± 2.81 mmol/L, P <.001). Compared with group A, the groups that completed more diabetes education courses had lower FBG (group B, β=-0.15, 95% CI -0.26－-0.03; group C, β= -0.29, 95% CI -0.41－-0.16; P for trend <.001) and PBG (group B, β=-0.29, 95% CI -0.46－-0.11; group C, β= -0.47, 95% CI -0.66－-0.28; P for trend <.001) and a higher frequency of SMBG at the 12th week (group B, β=1.17, 95% CI 0.81－1.53; group C, β = 4.21, 95% CI 3.81－4.62; P for trend <.001). Age and education were related to patients’ engagement in the diabetes education courses. Compared with young patients (18-34 years old), middle-aged patients (35-59 years old) and elderly patients (≥ 60 years old) completed more diabetes education courses (middle-aged group, β=2.22, P=.01; elderly group, β=2.42, P=.02).
Conclusions:
The app-based diabetes education is effective for glycemic control and SMBG behavior improvement in type 2 diabetic patients with insulin therapy. Young patients' engagement in the education courses is relatively low. We need to conduct in-depth interviews with users to further improve the curriculum.
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