A Mobile-Based Intervention for Glycemic Control in Patients With Type 2 Diabetes: Retrospective, Propensity Score-Matched Cohort Study (Preprint)
Authors: Li Jing , Sun Li , Wang Yaogang , Guo Lichuan , Li Daiqing , Liu Chang , Sun Ning , Xu Zheng , Li Shu , Jiang Yunwen , Wang Yuan , Zhang Shunming , Chen Liming 
Published: March 2020

BACKGROUND

Mobile-based interventions appear to be promising in ameliorating huge burdens experienced by patients with type 2 diabetes. However, it is unclear how effective mobile-based interventions are in glycemic management of patients with type 2 diabetes based on real-world evidence.

OBJECTIVE

This study aimed to evaluate the effectiveness of a mobile-based intervention on glycemic control in patients with type 2 diabetes based on real-world population data.

METHODS

This retrospective, propensity score-matched cohort study analyzed longitudinal data from a clinical electronic health database. The study population included 37,913 patients with type 2 diabetes at cohort entry between October 1, 2016, and July 31, 2018. A total of 2400 patients were matched 1:1, using propensity score matching, into the usual care and mobile health (mHealth) groups. The primary outcomes of glycemic control included control rates of glycated hemoglobin (HbA<sub>1c</sub>), fasting blood glucose (FBG), and postprandial 2-hour blood glucose (P2BG). Mean values and variation trends of difference with 95% CI were the secondary outcomes. The general linear model was used to calculate repeated-measures analyses of variance to examine the differences between the two groups. Subgroup and sensitivity analyses were performed.

RESULTS

Of the 2400 patients included in the analysis, 1440 (60.00%) were male and the mean age was 52.24 years (SD 11.56). At baseline, the control rates of HbA<sub>1c</sub>, FBG, and P2BG in the mHealth and usual care groups were 45.75% versus 47.00% (<i>P</i>=.57), 38.03% versus 32.76% (<i>P</i>=.07), and 47.32% versus 47.89% (<i>P</i>=.83), respectively. At the 3-, 6-, 9-, and 12-month follow-ups, the mHealth group reported higher control rates of HbA<sub>1c</sub> than did the usual care group: 69.97% versus 46.06% (<i>P</i>&lt;.001), 71.89% versus 61.24% (<i>P</i>=.004), 75.38% versus 53.44% (<i>P</i>&lt;.001), and 72.31% versus 46.70% (<i>P</i>&lt;.001), respectively. At the four follow-up sessions, the control rates of FBG in the mHealth and usual care groups were statistically different: 59.24% versus 34.21% (<i>P</i>&lt;.001), 56.61% versus 35.14% (<i>P</i>&lt;.001), 59.54% versus 34.99% (<i>P</i>&lt;.001), and 59.77% versus 32.83% (<i>P</i>&lt;.001), respectively. At the four follow-up sessions, the control rates of P2BG in the mHealth group were statistically higher than in the usual care group: 79.72% versus 48.75% (<i>P</i>&lt;.001), 80.20% versus 57.45% (<i>P</i>&lt;.001), 81.97% versus 54.07% (<i>P</i>&lt;.001), and 76.19% versus 54.21% (<i>P</i>=.001), respectively. At the four follow-up sessions, the percentages of HbA<sub>1c</sub> reduction in the mHealth group were 8.66% (95% CI 6.69-10.63), 10.60% (95% CI 8.66-12.54), 10.64% (95% CI 8.70-12.58), and 8.11% (95% CI 6.08-10.14), respectively. At the four follow-up sessions, the percentages of P2BG reduction in the mHealth group were 8.44% (95% CI 7.41-10.73), 17.77% (95% CI 14.98-20.23), 16.23% (95% CI 13.05-19.35), and 16.91% (95% CI 13.17-19.84), respectively. Starting from the sixth month, the mean HbA<sub>1c</sub> and P2BG values in the two groups increased slightly.

CONCLUSIONS

This mobile-based intervention delivered by a multidisciplinary team can better improve glycemic control rates of patients with type 2 diabetes than usual care. These effects were best sustained within the first 6 months. Starting from the sixth month, intensive management needs to be conducted to maintain long-term effectiveness of the mobile-based intervention.