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Improving Management of People with Type 2 Diabetes Using Digital Tools
ABSTRACT
Background:
Diabetes is present in 10.5% of the U.S. population and accounts for 14.3% of all office-based physician visits made by adults. Despite this established office-based approach, the disease and its adverse outcomes, including glycemic control and clinical events, tend to worsen over time. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record.
Objective:
To evaluate the impact of a virtual, home-based diabetes management program on clinical measures of diabetes control compared to usual care.
Methods:
We evaluated glycemic control and other diabetes-related measures after one year in 763 patients with type 2 diabetes enrolled into a home-based digital medicine diabetes program and compared them to 794 patients matched for age, sex, race, BMI, A1C, creatinine, eGFR, and insulin use in a usual care group after one year. Digital medicine patients completed questionnaires on-line, received medication management and lifestyle recommendations from a clinical pharmacist or APP and a health coach, and were asked to submit blood glucose readings using a commercially available Bluetooth enabled glucose meter that transmitted data directly to the electronic medical record.
Results:
After one-year, usual care patients demonstrated no significant changes in A1C (7.3±1.7 to 7.3±1.6; P =.41), or in the proportion of patients with A1C ≥ 9.0 (15% to 14%; P = .51). Digital medicine patients demonstrated improvements in A1C (7.3±1.5 to 6.9±1.2; P <.001), the proportion of patients with A1C ≥ 9.0 (14% to 6%; P <.001), diabetes distress (26% to 16%; P <.001), and in hypoglycemic episodes (41.1% to 11.9%; P <.001).
Conclusions:
A digital diabetes program is associated with significant improvement in glycemic control and other diabetes measures. Utilization of a virtual health intervention using connected devices was widely accepted across a broad range of ethnic diversity, ages, and levels of health literacy.
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