JMIR Publications

ABSTRACT

Background:

Self-monitoring of blood glucose (SMBG) using online diabetes management platforms has shown promise in type 2 diabetes (T2D) management.

Objective:

This study aimed to assess the effect of the ALRT Telehealth Solution, an FDA-cleared online platform incorporating SMBG with algorithm-guided insulin titration recommendations, on the hemoglobin A1c (HbA1c) in insulin-treated T2D.

Methods:

Adults with T2D on twice-daily premixed insulin, HbA1c ≥7.5% (58 mmol/mol) and <10% (86 mmol/mol), and BMI ≤40 kg/m² were enrolled. They measured blood glucose twice-daily and uploaded glucometer data weekly using the ALRT mobile-phone application, which then alerted physicians with algorithm-guided insulin titration recommendations. These were communicated back to participants via the app weekly. HbA1c and fasting plasma glucose (FPG) were measured at baseline, weeks 12 and 24.

Results:

We enrolled 25 adults (44.0% female, 52.0% Chinese), mean age 58.9 years. Adherence to twice-daily SMBG regimen was 97.4%. Over 24 weeks, mean total daily insulin dose increased from 0.73 to 0.79 units/kg/day. This led to a significant reduction in HbA1c from an average of 8.6% (70 mmol/mol) to 7.4% (57 mmol/mol) and FPG from an average of 8.7 to 7.1 mmol/L (both p<0.01). Most hypoglycemia events were mild (88.5%) (3.0-3.9 mmol/L), and the prevalence of hypoglycemia (<4.0 mmol/L) at 48.0% was similar to the self-reported baseline of 44.9%. There were more hypoglycemia episodes during the final 12 weeks of the study (72) than the first 12 weeks (25).

Conclusions:

An internet-based glucose monitoring system with structured SMBG and algorithm-guided insulin titrations significantly improved glycemia in individuals with insulin-treated T2D without increasing hypoglycemia.