## 4 Discussion
### Principle Results
Previous studies supporting the current results examined the impact of telemedicine tools, such as Internet-based intervention, on diabetes outcomes. The population participating in these studies were high-risk, low-income, and patients from ethnic minority groups, and showed significant reductions in A1C [36; 64; 65; 66]. Adjustments in usability and availability through a digital platform can engage at-risk populations and may lead to improved glycemic levels. Measuring outcomes among racial/ethnic groups is important to monitor in order to respond to long-standing disparities. Earlier systematic reviews identified numerous studies evaluating the impact of diabetes self-management interventions delivered via a mobile device and/or Internet on in-target glycemia for adult populations at high risk with T2 DM. Most studies reported that A1C improved within the intervention group versus usual care, emphasizing digital health preference above usual care [36]. The current results provide evidence that digital health among varied race/ethnicity groups assists in engaging users and improving their self-management associated with in-target glycemia for a year's duration. There is a lack of studies examining the impact of digital health interventions on chronic conditions and disease among populations at high risk, specifically among different racial/ethnic groups of people, with T2 DM. Most studies examined the impact of digital health on chronic conditions among vulnerable heterogeneous populations with general and broad definitions, e.g., low-income patients, low level of education, and mixed vulnerable classification. This study utilized real-world data logged into the app by users to stratify the high-risk population purely by race/ethnicity. It revealed no significant differences in their glycemic level over a meaningful period of 12 months. A WP population served here as a type of \"control\" for the different races/ethnicities assessed, while many previous studies are lacking in their comparison to a control group [36; 46; 53]. Digital therapeutic platform technology enables the recognition and adjustment of specific required needs (e.g., cultural, linguistic, educational, and more). Our findings provided evidence that a digital tool is equally useful among the varied racial/ethnic users studied. The usability and availability of personalized interventions enable the achievement of healthcare engagement over time. Previous real-world studies presented an association between digital engagement and clinical outcomes improvement among T2 DM users [67]. The current study reveals the association between app engagement and clinical outcomes in types of populations known as \"challenging\". The study findings showed a positive correlation between engagement and average blood glucose among REM and WP users. Findings also shed light on the mechanism of self-monitoring with a digital therapeutic platform and may assist in developing a better therapeutic approach targeting REM populations with T2 DM. The nondifference between improved in-target glycemia may be explained by the ability of digital therapeutics platforms to personalize the solutions according to the user's needs. The digital platform collects users' information via the screening process, tracks users' behaviors and glycemic levels, can personalize language communication, offer relevant educational content, and can provide online consultation with a coach. In addition, the usability and availability of the home glucometer with online feedback on glucose measurements encourage the user to keep tracking these measurements, which may increase healthcare engagement. The availability of important tracking tools with specific adjustments for varied populations' needs is a gold key in promoting in-target glycemia.