JMIR Publications

ABSTRACT

Background:

Remote data capture for blood glucose (BG) or blood pressure (BP) monitoring and the use of a supportive digital app is becoming the model in diabetes and hypertension chronic care. One of the goals in chronic condition management is to increase awareness and generate behavioral change in order to improve outcomes in diabetes and related comorbidities such as hypertension. In addition, there is a lack of understanding of the association between BG and BP levels when using digital health tools.

Objective:

By applying a rigorous study framework to digital health data, this study investigated the effect of BP monitoring on BG and BP levels as well as the association between BP and BG. We hypothesized that during the first 6 months of BP monitoring, BG and BP levels would decrease. Finally, we suggested a positive association between BG and BP levels.

Methods:

In this retrospective, quasi-experimental real-world study, we followed 269 people with type 2 diabetes (T2D) who tracked their BG levels with Dario digital therapeutic platform for a chronic condition. We analyzed digital data of the users who monitored their blood pressure “BPM” group (Blood Pressure Monitoring, n=137) 6 months before and after starting their monitoring. Propensity score matching established a control group “NBPM” (No Blood Pressure Monitoring, n=132) matched on demographic and baseline clinical measures to the BPM group. A piecewise mixed model was used for analyzing the time- trajectories of BG, BP, and their association.

Results:

Analysis revealed a significant difference in BG time trajectories associated with BP monitoring in BPM and NBPM groups (t=-2.12, P=0.034). BPM group demonstrated BG reduction improvement in the monthly average BG levels during the first 6 months (t=-3.57, P <0.001) while BG didn’t change for the NMBP group (t=0.39, P =0.70). Both groups showed similarly stable BG time trajectories (B=0.98, t=1.16, P =0.25) before starting the use of a blood pressure monitoring system. In addition, the BPM group showed a significant reduction in systolic (t=-6.42, P <0.0001) and diastolic (t=-4.80, P <0.0001) BP during the first 6 months of the BP monitoring. Finally, BG levels were positively associated ' with both systolic (t=2.28, P =0.02) and diastolic (t=2.11, P =0.03) BP.

Conclusions:

The results of this study shed light on the association between BG and BP levels and highlight a digital therapeutic platform as an available and easy-to-apply approach for the integrative management of BG and BP. Our findings also underscore the need and provide a basis for an all-inclusive approach to digital health in the treatment of chronic conditions.