The Effects of Continuous Usage of a Diabetes Management App on Glycemic Control in Real-world Clinical Practice: Retrospective Analysis

Abstract

Background: The efficacy of digital technology in improving diabetes management has typically been demonstrated through studies such as randomized controlled trials, which have reported a steeper reduction in hemoglobin A_1c (HbA_1c) values for patients who adopted a digital solution. However, evidence from real-world clinical practice is still limited.

Objective: This study aimed to evaluate the effectiveness of digital interventions by tracking HbA_1c improvements over 1 year in real-world clinical settings.

Methods: Patients used the Health2Sync mobile app to track self-measured outcomes and communicate with health care professionals (HCPs). HCPs used the web-based Patient Management Platform to monitor patient data, view test results from clinical laboratories, and communicate with patients. Patients who have been onboarded for at least 13 months and have consecutive HbA_1c findings for 5 quarters were included in the analysis. They were then stratified into 3 groups (high, mid, and low retention) based on their level of use of Health2Sync in the first 6 months of onboarding. A mixed model was built to compare the slopes of the rate of reduction in HbA_1c among the groups. In addition, these patients' retention on the app from the seventh to the 12th month was verified through multiple comparisons.

Results: A sample of 2036 users was included in the analysis. With the mixed model coefficient estimates, we found that app users had significant HbA_1c percentage reductions as the passed quarter count increased (t=-9.869; P<.001), and that effectiveness increased in the high (t=-5.173) and mid retention (t=-6.620) groups as the interaction effects were significantly negative compared to that in the low retention group (P<.001) in the passed quarter count. The low retention group also had the highest average HbA_1c value at the end of 13 months (high: 7.01%, SD 1.02%; mid: 6.99%, SD 1.00%; low: 7.17%, SD 1.14%) (Bonferroni correction: high vs low, P=.07; mid vs low, P=.02; high vs mid, P>.99). The level of use of the app remained consistent in the seventh to the 12th month after onboarding (high: 5.23 [SD 1.37] months, mid: 2.43 [SD 1.68] months, low: 0.41 [SD 0.97] months) (P<.001).

Conclusions: Our analysis shows that continuous usage of the diabetes management app is associated with better glycemic control in real-world clinical practice. Further studies are required to reveal the efficacy for specific diabetes types and to observe effects beyond 1 year.

Keywords: app; diabetes; diabetes care; digital intervention; digital therapeutics; glycemic control; mHealth; mobile app; real-world data; therapy.

Figure 1

Screenshots of the Health2Sync app and Patient Management Platform.

Figure 2

Inclusion flow chart of this study. The final 3 groups were separated by their retention in the first 6 months. Sample sizes of each stage are noted. PMP: Patient Management Platform.

Figure 3

Users' averaged percentage change in HbA_1c levels in each time bucket. The error bars represent the SE among users in the group.

Figure 4

Jittered scatter plot depicting the relationship between HbA_1c percentage changes and time periods after joining the Patient Management Platform. Each dot represents 1 user's data at the time. The overlaid regression lines are based on the estimated coefficients from the mixed model.

Figure 5

Users' mean HbA_1c in each time bucket. The error bars represent the standard errors among users in the group.

Figure 6

Month count when the app was opened during the seventh to 12th month. The heights of the bars and the ranges of error bars represent the mean (SE) values in each group, respectively.