A Smartphone Application to Deliver a Treat-to-Target Insulin Titration Algorithm in Insulin-Naive Patients With Type 2 Diabetes: A Pilot Randomized Controlled Trial

Bee, Yong Mong; Batcagan-Abueg, Ada Portia M; Chei, Choy Lye; Kyung, Young; Haaland, Benjamin; Goh, Su-Yen; Lee, Phong Ching; Chiam, Priscilla Pei Sze; Ho, Emily Tse Lin; Matchar, David B.

doi:10.2337/dc16-0419

Cited by 24 publications

(40 citation statements)

References 2 publications

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“…During the study, there was an average drop from 9.9% to 8.8% after 6 weeks and to 8.2% after 12 weeks, with no statistically significant difference between the two groups (p = 0.88). Finally, it is noteworthy that no episodes of severe hypoglycemia were recorded [29].…”

Section: Diabetes Palmentioning

confidence: 91%

Smartphone-Based Technology in Diabetes Management

et al. 2020

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Diabetes is a group of metabolic disorders characterized by elevated levels of blood glucose which leads over time to serious complications and significant morbidity and mortality worldwide. Self-management tasks in diabetes may be quite challenging because of lack of training, difficulties in sustaining lifestyle modifications, and limited access to specialized healthcare. Nowadays, the evolution of mobile technology provides a large number of health-related smartphone applications (apps), aiming to increase the self-management skills of the patient in chronic diseases, to facilitate the communication between the patient and healthcare providers, and to increase also the patient's compliance with the treatment. In the field of diabetes there are also many diabetesrelated mobile apps mainly focusing on selfmanagement of diabetes, lifestyle modification, and medication adherence motivation. The aim of this paper is to review the most important diabetes-related mobile smartphone applications, including only those supported by prospective randomized controlled trials.

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Section: Diabetes Palmentioning

confidence: 91%

Smartphone-Based Technology in Diabetes Management

et al. 2020

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“…This is the case for the PREDICTIVE 303 algorithm, 8,9 the LTHome system 10 and TeLiPro. 11 Studies with the Diabetes Pal smartphone 12 showed an additional HbA1c reduction (−0.7%) by using an algorithmic insulin titration guidance (d-Nav device) with HCP support F I G U R E 2 A, Changes from baseline in HbA1c levels at M4 and M13. HbA1c levels decreased more in patients from the G2 and G3 arms compared with the control arm, G1 (−0.53% and −0.51%, respectively; ***P < 0.002).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of two telemonitoring systems to improve glycaemic control during basal insulin initiation in patients with type 2 diabetes: The TeleDiab‐2 randomized controlled trial

Franc

Joubert

Daoudi

et al. 2019

Diabetes Obesity Metabolism

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TeleDiab‐2 was a 13‐month randomized controlled trial evaluating the efficacy and safety of two telemonitoring systems to optimize basal insulin (BI) initiation in subjects with inadequately controlled type 2 diabetes (HbA1c, 7.5%‐10%). A total of 191 participants (mean age 58.7 years, mean HbA1c 8.9%) were randomized into three groups: group 1(G1, standard care, n = 63), group 2 (G2, interactive voice response system, n = 64) and group 3 (G3, Diabeo‐BI app software, n = 64). The two telemonitoring systems proposed daily adjustments of BI doses, in order to facilitate the achievement of fasting blood glucose (FBG) values targeted at ~100 mg/dL. At 4 months follow‐up, HbA1c reduction was significantly higher in the telemonitoring groups (G2: −1.44% and G3: −1.48% vs. G1: −0.92%; P < 0.002). Moreover, target FBG was reached by twice as many patients in the telemonitoring groups as in the control group, and insulin doses were also titrated to higher levels. No severe hypoglycaemia was observed in the telemonitoring groups and mild hypoglycaemia frequency was similar in all groups. In conclusion, both telemonitoring systems improved glycaemic control to a similar extent, without increasing hypoglycaemic episodes.

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“…A solution to provide ongoing diabetes self-management support could be the use of mobile health (mHealth): healthcare delivered via mobile devices. The effectiveness of mHealth as a vehicle for diabetes self-management education and support (DSME/S) has previously been investigated with a great variety of interventions: some trials provided general DSME/S,1–4 others focused on specific topics such as medication adherence,5 6 physical activity,7 or insulin titration 8. While some found a statistically significant decrease in HbA1c of approximately 0.6%,2 3 others did not 1 7 8.…”

Section: Introductionmentioning

confidence: 99%

“…The effectiveness of mHealth as a vehicle for diabetes self-management education and support (DSME/S) has previously been investigated with a great variety of interventions: some trials provided general DSME/S,1–4 others focused on specific topics such as medication adherence,5 6 physical activity,7 or insulin titration 8. While some found a statistically significant decrease in HbA1c of approximately 0.6%,2 3 others did not 1 7 8. Only a few studies analyzed the prespecified sample size1 2 7; many studies were underpowered or were pilot studies with small sample size 3–5 8.…”

Section: Introductionmentioning

confidence: 99%

“…While some found a statistically significant decrease in HbA1c of approximately 0.6%,2 3 others did not 1 7 8. Only a few studies analyzed the prespecified sample size1 2 7; many studies were underpowered or were pilot studies with small sample size 3–5 8. All but two of these trials5 8 included mostly patients who were not on insulin therapy.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of diabetes self-management education and support via a smartphone application in insulin-treated patients with type 2 diabetes: results of a randomized controlled trial (TRIGGER study)

Boels

Vos

Dijkhorst-Oei

et al. 2019

BMJ Open Diab Res Care

101

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ObjectiveTo investigate the effect of diabetes self-management education and support via a smartphone app in individuals with type 2 diabetes on insulin therapy.Research design and methodsOpen two-arm multicenter parallel randomized controlled superiority trial. The intervention group (n=115) received theory and evidence-based self-management education and support via a smartphone app (optionally two or six times per week, once daily at different times). The control group (n=115) received care as usual. Primary outcome: HbA1c at 6 months. Other outcomes included HbA1c ≤53 mmol/mol (≤7%) without any hypoglycemic event, body mass index, glycemic variability, dietary habits and quality of life. We performed multiple imputation and regression models adjusted for baseline value, age, sex, diabetes duration and insulin dose.ResultsSixty-six general practices and five hospital outpatient clinics recruited 230 participants. Baseline HbA1c was comparable between groups (8.1% and 8.3%, respectively). At 6 months, the HbA1c was 63.8 mmol/mol (8.0%) in the intervention vs 66.2 mmol/mol (8.2%) in the control group; adjusted difference −0.93 mmol/mol (−0.08%), 95% CI −4.02 to 2.17 mmol/mol (−0.37% to 0.20%), p=0.557. The odds for achieving an HbA1c level ≤7% without any hypoglycemic event was lower in the intervention group: OR 0.87, 95% CI 0.33 to 2.35. There was no effect on secondary outcomes. No adverse events were reported.ConclusionsThis smartphone app providing diabetes self-management education and support had small and clinically not relevant effects. Apps should be more personalized and target individuals who think the app will be useful for them.Trial registration numberNTR5515.

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A Smartphone Application to Deliver a Treat-to-Target Insulin Titration Algorithm in Insulin-Naive Patients With Type 2 Diabetes: A Pilot Randomized Controlled Trial

Cited by 24 publications

References 2 publications

Smartphone-Based Technology in Diabetes Management

Smartphone-Based Technology in Diabetes Management

Efficacy of two telemonitoring systems to improve glycaemic control during basal insulin initiation in patients with type 2 diabetes: The TeleDiab‐2 randomized controlled trial

Effectiveness of diabetes self-management education and support via a smartphone application in insulin-treated patients with type 2 diabetes: results of a randomized controlled trial (TRIGGER study)

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