Mobile app interventions for people with diabetes improved glycemic control in separate studies reported at the annual scientific sessions of the American Diabetes Association, San Francisco.
Interim results from a prospective randomized controlled study of 106 patients from a medically underserved Hispanic population with poorly controlled type 2 diabetes found that hemoglobin A1c (HbA1c) levels decreased by an average of a relative 12% after 6 months in those who used a text-messaging intervention called Dulce Digital on their mobile phones in addition to receiving usual care, compared with a 2% relative decrease in the control patients who received usual care alone.
Maria Isabel Garcia
Mean HbA1c levels decreased from 9.4% at baseline in the Dulce Digital group to 8.4% after 3 months and at 6 months. In the control group, mean HbA1c levels started at 9.5%, decreased to 9.2% at 3 months, and increased to 9.3% at 6 months. The differences between groups were statistically significant, nurse practitioner Maria Isabel Garcia reported.
Changes in other measures, including weight, blood pressure, or lipids, did not differ significantly between groups, said Ms. Garcia of Scripps Health, San Diego.
Patients in the Dulce Digital group who had no cell phone or had limited text-messaging service, received a phone with unlimited messaging. They then received two or three texts per day initially, with the frequency tapering over a 6-month period. Three kinds of texts were sent. Educational messages included a reminder to "Use small plates! Portions will look larger, and you may feel more satisfied after eating." Medication reminders might say, "Tick, tock. Take your medication at the same time every day!" Blood glucose prompts reminded patients, "Time to check your blood sugar! Text back your results."
Nurses monitored blood glucose responses and called the patient if they saw one reported value greater than 250 mg/L or less than 70 mg/dL, three values in the 181- to 250-mg/dL range within 1 month, or no texts back for 1 week.
"Ninety-one percent of the U.S. population already has a cell phone. So let’s use that as a way to circumvent these barriers to access to care," Ms. Garcia said. She and her associates are pursuing funding for further study of Dulce Digital with longer follow-up.
Dr. Sylvia Franc
In a separate randomized, controlled French study of 190 adults with type 2 diabetes who were starting insulin, the Telediab2 software system loaded onto patients’ phones nearly doubled the likelihood that patients would achieve HbA1c levels of less than 7% by 13 months (31%), compared with patients in a control group or a third group who used a simplified software intervention for only the first 4 months (19%), Dr. Sylvia Franc reported in a poster presentation.
The TeleDiab2 system provides automatic basal insulin titration based on blood glucose targets and rules devised by the treating physician, as well as automatic personalized coaching for blood glucose monitoring, diet, and physical activity based on pre- and postprandial blood glucose values. The app enables remote telemonitoring and short teleconsultations, said Dr. Franc of Sud-Francilien Hospital, Corbeil Essones, France.
Physicians initiated and titrated basal insulin at baseline. Patients in the control group then received face-to-face consultations every 3 months. The simplified intervention group received phone consultations through the app for the first 4 months (and had significantly improved HbA1c levels, compared with the control group, in that period), then had face-to-face visits every 3 months. Patients in the Telediab2 group had no face-to-face visits; they had phone consultations every 2 weeks until month 4, then monthly phone consultations.
Mobile technology also impressed attendees at the meeting in four small studies showing progress in early attempts to develop an "artificial pancreas." In two 5-day crossover studies, 52 U.S. adults and adolescents with type 1 diabetes using a bionic insulin-glucagon pancreas achieved better glycemic control than did patients using insulin pump therapy (N. Engl. J. Med. 2014 June 15 [doi:10.1056/NEJMoa1314474]). The FlorenceD2 closed-loop insulin delivery system seemed to improve glucose control when used by patients at home in two small European randomized crossover studies.
Dr. Garcia and Dr. Franc reported having no financial disclosures. Lifescan, which sells glucose monitoring products, supported Dr. Garcia’s study.
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