Effect of Digital-Tool-Supported Basal Insulin Titration Algorithm in Reaching Glycemic Control in Patients with Type 2 Diabetes in Mexico

Abstract

Background: My Dose Coach (MDC) is a mobile application combined with a web portal that can suggest optimized basal insulin (BI) injection doses using Self-Measured Plasma Glucose (SMPG) and hypoglycemia data. This study aimed to evaluate its efficacy on patients reaching SMPG and Fasting blood glucose (FBG) target range 90-130 mg/dl (5-7.2 mmol/L) goals without severe hypoglycemic episodes. We also addressed the mean reduction in glycated hemoglobin (A1C), FBG, and SMPG and the improvement in the WHO’s Five Well Being Index (WBI). Methods: This prospective pilot study involved the use of MDC in outpatients with type 2 diabetes (T2DM) from a Hospital in Northern Mexico. Patients on treatment with any BI were included in the study. The follow-up was of 16 weeks. Student t-tests or McNemar test were used for effect comparisons. Results: We included 158 patients (46.8% women), mean (SD) age 51 (10.3) years. We achieved SMPG target range in 58.9% [mean (95CI) reduction of 30.9 mg/dl (22.5-37.7; P < .001)] of the patients [66(28) days], with no severe hypoglycemia events. FBG goal was reached in 55.7% [mean (95CI) reduction of 63.4 mg/dl (49.6-77.2; P < .001)]. The mean (95CI) reduction of A1C was 1.78% (1.47-2, P < .01) with the last observation carried forward. There was a mean (95CI) increase of 2.23 (−3, −1.4, P < .01) points in WBI scale. Conclusions: MDC successfully helped to achieve FBG and SMPG goals, reduced A1C, and increased WBI with no severe hypoglycemia events.

Real‐world effectiveness and safety of insulin glargine 300 U/ml in insulin‐naïve people with type 2 diabetes in the Latin America region: A subgroup analysis of the ATOS

“…As recommended by the World Health Organization, 32 there is a need to strengthen the use of digital technology and other resources for improving the clinical management of diabetes, such as My Dose Coach, a digital app that supports people with T2D during basal insulin titration. 33 Importantly, the results from ATOS LATAM should be interpreted with caution because of several limitations, consisting of the small sample size, a lack of randomization and the lack of a comparator arm.…”

“…As recommended by the World Health Organization, 32 there is a need to strengthen the use of digital technology and other resources for improving the clinical management of diabetes, such as My Dose Coach, a digital app that supports people with T2D during basal insulin titration. 33 …”

“…In addition, these real‐world data help with work on the healthcare systems, to incorporate new multidisciplinary policies and practice guidelines that will guide primary care physicians in reducing the burden of disease and improving healthcare outcomes, as well as the quality life of people with T2D in the LATAM region. As recommended by the World Health Organization, 32 there is a need to strengthen the use of digital technology and other resources for improving the clinical management of diabetes, such as My Dose Coach, a digital app that supports people with T2D during basal insulin titration 33 …”

Evaluation of a Digital Health Tool for Titration of Basal Insulin in People With Type 2 Diabetes: Rationale and Design of a Randomized Controlled Trial

“…21 In a pilot study of 158 patients with T2DM using the digital health tool in Mexico, 58.9% of participants reached their target self-measured plasma glucose level with a mean reduction of 30.9 mg/dL. 20 Target fasting blood glucose level was reached in 55.7% of participants with a mean reduction of 63.4 mg/dL and no severe hypoglycemic events. HbA1c was reduced by 1.78% on average with the last observation carried forward.…”

“…This health tool has already been implemented in India and Mexico and evaluated in independent pilot studies. [20][21][22] The results from these studies demonstrated that the use of this digital health tool successfully decreased HbA1c levels, achieved easier target fasting blood glucose levels, and improved overall well-being without any severe hypoglycemic events. [20][21][22] The aim of this multicenter randomized controlled study is to investigate the effectiveness of using this digital health tool in improving glycemic control as a medical benefit and patient-relevant structural and procedural improvements, as assessed by patient-reported outcomes via the implementation of the physician-determined titration algorithm in patients' daily lives within the German healthcare system.…”