Improvements in Glycemic Control and Depressive Symptoms among adults with Type 2 Diabetes: A Retrospective Study (Preprint)
Authors: Venkatesan Aarathi , Zimmermann Gretchen , Rawlings Kelly , Ryan Claudia , Voelker Louise , Edwards Caitlyn 
Published: August 2022

BACKGROUND

The prevalence of diabetes remains high, with traditional lifestyle interventions demonstrating limited success in improving diabetes-related outcomes, particularly among individuals with diabetes related mental health comorbidities. Digital health interventions provide the ability to ease the sustained and rigorous self-management needs associated with diabetes care and treatment. Current interventions though, are plagued by small sample sizes, underpowered pilot studies, and immense heterogeneity in program intervention, duration, and measured outcomes.

OBJECTIVE

Therefore, this work aimed to evaluate the effectiveness of an mHealth diabetes management program on measures of glycemic control in a high risk population with type 2 diabetes (hemoglobin A1c (HbA1c) ≥ 8.0%), utilizing a sample of 1,128 participants who provided baseline and follow-up data. Sustainability of this change in glycemic control was examined in a subset of participants (n = 455) at 6-months and 1- year following program enrollment. A secondary analysis examined changes in glycemic control among a subset of participants with self-reported mild to moderate depression at baseline.

METHODS

This study utilized a single-arm, retrospective design. Participants were enrolled in the Vida Health Diabetes Management Program. This app-based intervention utilized one-on-one remote sessions with a Health Coach, Registered Dietitian Nutritionist, and/or a Certified Diabetes Care and Education Specialist and structured lessons and tools related to diabetes management and self-care. Participants provided baseline (-365 to 21 days of program enrollment) HbA1c values as well as follow-up (at least 90 days following program enrollment). Paired t-tests were used to evaluate changes in HbA1c between baseline and follow-up time points. The Patient Health Questionnaire (PHQ-8) and the Generalized Anxiety Disorder Scale (GAD-7) were utilized to assess self-reported depressive and anxiety symptoms, respectively. Paired t-tests and linear regression modeling accounting for pertinent covariates were used to evaluate changes in mental health symptom acuity and their relationship with changes in glycemic control.

RESULTS

We observed a significant decrease in HbA1c of -1.35 points between baseline (mean: 9.84, SD: 1.64) and follow-up (mean: 8.48, SD: 1.77; t=22.56; P<0.001) among this large, high-risk sample. This decrease was sustained up to one year following program enrollment. Additionally, a significant relationship between improvements in depressive symptom acuity and improvements in HbA1c was observed (β=–0.74, P=0.03).

CONCLUSIONS

The present study demonstrates clinically meaningful improvements in glycemic control among participants enrolled in the Vida Health Diabetes Management Program. Additionally, this work presents the one of the largest studied samples of participants enrolled in a digital health diabetes management program to date.

CLINICALTRIAL

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