Clinical Impact of Personalized Physician's Education and Remote Feedback Via a Digital Platform on Glycemic Control: Pilot Randomized Controlled Trial

Abstract

Background: The digital education platform Doctorvice (iKooB Inc.) offers face-to-face physician-patient education during outpatient clinic visits, remote glucose monitoring, and the delivery of educational messages, and is expected to be effective for personalized diabetes care.

Objective: This study aims to evaluate the effectiveness of the digital education platform for diabetes care by comparing cases that included both face-to-face education and remote monitoring with those that included only face-to-face education.

Methods: This was a randomized clinical study conducted at the Diabetes Center of Seoul St. Mary's Hospital. Participants were aged ≥19 years and had glycated hemoglobin (HbA_1c) levels between 7.5% and 9.5%. In the intervention group, physicians used the digital education platform to provide face-to-face education at enrollment and at the 3- and 6-month visits, along with remote monitoring during the first 3 months of the 6-month study period. The control group received conventional outpatient education. Both groups completed questionnaires-assessing satisfaction with diabetes treatment, diabetes-related stress, and adherence to diabetes medication-at the beginning and end of the study. The primary endpoint was the change in HbA_1c levels.

Results: A total of 66 participants were enrolled between August 1, 2022, and August 31, 2023. Of these, 26 in the intervention group and 30 in the control group were analyzed, excluding 10 participants who dropped out of the study. The mean baseline HbA_1c levels were 8.3% (SD 0.6%) in the intervention group and 8.0% (SD 0.5%) in the control group. At the 3-month follow-up, mean HbA_1c decreased by 0.5%-7.8% (SD 0.9%; P=.01) in the intervention group and by 0.2%-7.8% (SD 0.7%) in the control group. HbA_1c levels substantially improved during the first 3 months with both face-to-face education and remote glucose monitoring. However, HbA_1c tended to increase during the 3- to 6-month follow-up in the intervention group without the remote monitoring service. Satisfaction with diabetes treatment significantly improved at the end of the study compared with baseline in the intervention group (mean change +3.6 points; P=.006). Medication adherence improved in both groups, with no significant difference at 6 months (P=.59), although the intervention group showed a greater increase from baseline. Subgroup analysis indicated that the reduction in HbA_1c was greater for patients with baseline HbA_1c levels ≥8.0%, those aged ≥65 years, smokers, drinkers, and those with obesity in the intervention group.

Conclusions: The digital education platform for personalized diabetes management may be beneficial for glycemic control in type 2 diabetes mellitus. Its effectiveness appears to be enhanced when physicians provide personalized face-to-face education combined with remote feedback.

Trial registration: Clinical Research Information Service (CRiS) of Republic of Korea KCT0007953; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23507&search_page=L.

Keywords: digital health; distance counseling; education, distance; remote patient monitoring; type 2 diabetes mellitus.

Figure 1

Study design in the intervention group. SMBG: self-measured blood glucose.

Figure 2

CONSORT flowchart.

Figure 3

Changes in glycated hemoglobin (HbA_1c) after education using the digital platform. *The change in HbA_1c from baseline to 3 months was significant in the intervention group (P=.01).

Figure 4

(A) Changes in the “satisfaction with diabetes treatment” score. (B) Changes in the “diabetes stress measurement” score. (C) Changes in the “adherence of diabetes medication” score. *The change in the satisfaction score was significant in the intervention group (P=.006). Vertical error bars indicate SD.

Figure 5

Changes in glycated hemoglobin (HbA_1c) according to self-measured blood glucose (SMBG) upload frequency. *Group 1 had a significantly greater reduction in HbA_1c compared with group 4 (post hoc analysis P=.02).

Figure 6

(A-1) Changes in HbA_1c according to age (≥65 years vs <65 years) in the intervention group. (A-2) Changes in HbA_1c according to age (≥65 years vs <65 years) in the control group. (B-1) Changes in HbA_1c according to baseline HbA_1c (8.0%) in the intervention group. (B-2) Changes in HbA_1c according to baseline HbA_1c (8.0%) in the control group. (C-1) According to smoking status in the intervention group. (C-2) Changes in HbA_1c according to smoking status in the control group. (D-1) Changes in HbA_1c according to drinking status in the intervention group. (D-2) Changes in HbA_1c according to drinking status in the control group. (E-1) Changes in HbA_1c according to BMI level in the intervention group. (E-2) Changes in HbA_1c according to BMI level in the control group. *Compared with baseline, change in HbA_1c at 3 months was significant in the intervention group. #There was a significant difference in the degree of HbA_1c change between the 2 groups. HbA_1c: glycated hemoglobin.