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. 2022 Oct 3;7(4):e40377.
doi: 10.2196/40377.

Effects of a Digital Patient Empowerment and Communication Tool on Metabolic Control in People With Type 2 Diabetes: The DeMpower Multicenter Ambispective Study

Domingo Orozco-Beltrán  1 , Cristóbal Morales  2   3 , Sara Artola-Menéndez  4 , Carlos Brotons  5 , Sara Carrascosa  6 , Cintia González  7 , Óscar Baro  8 , Alberto Aliaga  9 , Karine Ferreira de Campos  10 , María Villarejo  10 , Carlos Hurtado  10 , Carolina Álvarez-Ortega  10 , Antón Gómez-García  10 , Marta Cedenilla  10 , Gonzalo Fernández  10
Affiliations

Effects of a Digital Patient Empowerment and Communication Tool on Metabolic Control in People With Type 2 Diabetes: The DeMpower Multicenter Ambispective Study

Domingo Orozco-Beltrán et al. JMIR Diabetes. .

Abstract

Background: Diabetes is a major health care problem, reaching epidemic numbers worldwide. Reducing hemoglobin A1c (HbA1c) levels to recommended targets is associated with a marked decrease in the risk of type 2 diabetes mellitus (T2DM)-related complications. The implementation of new technologies, particularly telemedicine, may be helpful to facilitate self-care and empower people with T2DM, leading to improved metabolic control of the disease.

Objective: This study aimed to analyze the effect of a home digital patient empowerment and communication tool (DeMpower App) on metabolic control in people with inadequately controlled T2DM.

Methods: The DeMpower study was multicenter with a retrospective (observational: 52 weeks of follow-up) and prospective (interventional: 52 weeks of follow-up) design that included people with T2DM, aged ≥18 and ≤80 years, with HbA1c levels ≥7.5% to ≤9.5%, receiving treatment with noninsulin antihyperglycemic agents, and able to use a smartphone app. Individuals were randomly assigned (2:1) to the DeMpower app-empowered group or control group. We describe the effect of empowerment on the proportion of patients achieving the study glycemic target, defined as HbA1c≤7.5% with a ≥0.5% reduction in HbA1c at week 24.

Results: Due to the COVID-19 pandemic, the study was stopped prematurely, and 50 patients (33 in the DeMpower app-empowered group and 17 in the control group) were analyzed. There was a trend toward a higher proportion of patients achieving the study glycemic target (46% vs 18%; P=.07) in the DeMpower app group that was statistically significant when the target was HbA1c≤7.5% (64% vs 24%; P=.02) or HbA1c≤8% (85% vs 53%; P=.02). The mean HbA1c was significantly reduced at week 24 (-0.81, SD 0.89 vs -0.15, SD 1.03; P=.03); trends for improvement in other cardiovascular risk factors, medication adherence, and satisfaction were observed.

Conclusions: The results suggest that patient empowerment through home digital tools has a potential effect on metabolic control, which might be even more relevant during the COVID-19 pandemic and in a digital health scenario.

Keywords: HbA; adherence; diabetic; digital tool; empowerment; glycated hemoglobin; glycemic control; health app; home based; home care; home digital tool; metabolic; observational study; satisfaction; self-management; telemedicine; type 2 diabetes.

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Conflict of interest statement

Conflicts of Interest: DOB received consulting fees from MSD and payments for lectures including payments for serving on speaker bureaus from Lilly, Novo Nordisk, and Sanofi Pasteur. CM received fees for participation in review activities such as data monitoring boards, statistical analysis, and end point committees through his institution, Hospital Universitario Virgen Macarena. KFC, MV, CH, CAO, AGG, MC, and GF are full-time employees at MSD Spain. SAM, CB, SC, CG, OB, and AA have no potential conflicts of interest.

Figures

Figure 1
Figure 1
Study flowchart. HbA1c: hemoglobin A1c; IC: informed consent; T2DM: type 2 diabetes mellitus.
Figure 2
Figure 2
Primary composite outcome and individual components. Primary composite outcome refers to the proportion of patients achieving the study glycemic target (HbA1c≤7.5% with a reduction in HbA1c≥0.5% with respect to baseline value) at week 24. HbA1c: hemoglobin A1c.
Figure 3
Figure 3
Proportion of patients with HbA1c≤7%, HbA1c≤8%, and individualized HbA1c target established by the investigator at week 24. HbA1c: hemoglobin A1c.
Figure 4
Figure 4
Changes in HbA1c from baseline to week 24. HbA1c: hemoglobin A1c. *Least square means with adjustments for changes in antidiabetic treatment, age, sex, duration of diabetes, smoking status, socioeconomic status, educational level, and employment situation.
See this image and copyright information in PMC

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