JMIR Publications

ABSTRACT

Background:

Despite advances in treatments, adherence to therapies and metabolic control among patients with type 2 diabetes remain challenging. The use of new tech-nologies, such as telemedicine, digitalized systems or social networks could improve self-management and disease control.

Objective:

To evaluate the efficacy of a digital educational intervention in patients with type 2 diabetes, expressed as change in HbA1c and body composition and evalua-tion of response using validated questionnaires of satisfaction with healthcare professionals (IEXPAC), knowledge of their disease (ECODI) and adherence to treatment over six months of follow-up (Morisky-Green).

Methods:

This was a multicenter, randomized, prospective study that included adults with type 2 diabetes with poor metabolic control, who started treatment with GLP-1 receptor agonists, with the ability to use digital tools, especially via smartphone. Patients were randomized to digital intervention or usual care. The intervention group received education through social networks and digital tools (pedometer activation, sending healthy habits guidelines), in a structured program of healthy lifestyle changes. All this, through the figure of a "Digital Coach" for weekly and on-demand advice and support on an individualized basis. Baseline and follow-up data were collected on demographic characteristics, clinical parameters, treatment adherence, and quality of life.

Results:

A total of 85 patients were included, 41 in the control group and 44 in the inter-vention group. Both groups were matched regarding demographics, physical examination, insulin treatment and biochemical parameters. We observed a reduction of body weight and body mass index in both groups, greater in the intervention group (8.7±6.1 vs. 4.9±5.0 Kg; t-test value P=.002 and 3.0±2.1 vs. 1.8±1.8 Kg/m2, t-test value P=.006, respectively), as well as fat mass. Likewise, there were higher reductions of fasting plasma glucose and HbA1c in the inter-vention group (122.6±81.5 vs. 70.5±72.9 mg/dl, t-test value P=.004 and 3.7±1.9% vs. 2.6±2.1% vs, t-test value P=.006, respectively). Whereas there was no significant change in EsDQOL satisfaction score in the control group after 6 months of follow-up, there was a marked reduction of EsDQOL satisfac-tion score in the intervention group (0.7±19.8 vs. 13.7±23.1, t-test value P=.02). According to ECODI scale, the knowledge about diabetes increased to a higher extent in the intervention group (0.3±1.8 vs. 1.5±1.5, t-test value P=.001). Whereas medication adherence worsened in the control group after 6 months, it significantly improved with intervention (8.0% vs. 13.8%, chi-square P=.01). Patient's healthcare experience improved in the intervention, but not in the con-trol group.

Conclusions:

The digital educational intervention was shown to be effective in improving gly-cemic control, body composition, adherence and patient satisfaction compared to usual care in patients with type 2 diabetes. Based on these observations, the implementation of digital tools and social media could highly improve the multi-disciplinary approach of the management of this population.