Orozco-Beltrán Domingo, Morales Cristóbal, Artola-Menéndez Sara, Brotons Carlos, Carrascosa Sara, González Cintia, Baro Óscar, Aliaga Alberto, Ferreira de Campos Karine, Villarejo María, Hurtado Carlos, Álvarez-Ortega Carolina, Gómez-García Antón, Cedenilla Marta, Fernández Gonzalo
Department of Clinical Medicine, Miguel Hernandez University, Alicante, Spain.
Department of Endocrinology, Hospital Universitario Virgen Macarena, Seville, Spain.
JMIR Diabetes. 2022 Oct 3;7(4):e40377. doi: 10.2196/40377.
Diabetes is a major health care problem, reaching epidemic numbers worldwide. Reducing hemoglobin A (HbA) levels to recommended targets is associated with a marked decrease in the risk of type 2 diabetes mellitus (T2DM)-related complications. The implementation of new technologies, particularly telemedicine, may be helpful to facilitate self-care and empower people with T2DM, leading to improved metabolic control of the disease.
This study aimed to analyze the effect of a home digital patient empowerment and communication tool (DeMpower App) on metabolic control in people with inadequately controlled T2DM.
The DeMpower study was multicenter with a retrospective (observational: 52 weeks of follow-up) and prospective (interventional: 52 weeks of follow-up) design that included people with T2DM, aged ≥18 and ≤80 years, with HbA levels ≥7.5% to ≤9.5%, receiving treatment with noninsulin antihyperglycemic agents, and able to use a smartphone app. Individuals were randomly assigned (2:1) to the DeMpower app-empowered group or control group. We describe the effect of empowerment on the proportion of patients achieving the study glycemic target, defined as HbA≤7.5% with a ≥0.5% reduction in HbA at week 24.
Due to the COVID-19 pandemic, the study was stopped prematurely, and 50 patients (33 in the DeMpower app-empowered group and 17 in the control group) were analyzed. There was a trend toward a higher proportion of patients achieving the study glycemic target (46% vs 18%; P=.07) in the DeMpower app group that was statistically significant when the target was HbA≤7.5% (64% vs 24%; P=.02) or HbA≤8% (85% vs 53%; P=.02). The mean HbA was significantly reduced at week 24 (-0.81, SD 0.89 vs -0.15, SD 1.03; P=.03); trends for improvement in other cardiovascular risk factors, medication adherence, and satisfaction were observed.
The results suggest that patient empowerment through home digital tools has a potential effect on metabolic control, which might be even more relevant during the COVID-19 pandemic and in a digital health scenario.
糖尿病是一个重大的医疗保健问题，在全球范围内呈流行趋势。将血红蛋白A（HbA）水平降至推荐目标与2型糖尿病（T2DM）相关并发症风险的显著降低相关。新技术的应用，尤其是远程医疗，可能有助于促进自我护理并增强T2DM患者的能力，从而改善疾病的代谢控制。
本研究旨在分析一种家庭数字患者赋能与沟通工具（DeMpower应用程序）对T2DM控制不佳患者代谢控制的影响。
DeMpower研究采用多中心设计，包括回顾性（观察性：52周随访）和前瞻性（干预性：52周随访），纳入年龄≥18岁且≤80岁、HbA水平≥7.5%至≤9.5%、接受非胰岛素降糖药物治疗且能够使用智能手机应用程序的T2DM患者。个体被随机分配（2:1）至DeMpower应用程序赋能组或对照组。我们描述了赋能对达到研究血糖目标的患者比例的影响，该目标定义为在第24周时HbA≤7.5%且HbA降低≥0.5%。
由于COVID-19大流行，研究提前终止，共分析了50例患者（DeMpower应用程序赋能组33例，对照组17例）。DeMpower应用程序组中达到研究血糖目标的患者比例有升高趋势（46%对18%；P = 0.07），当目标为HbA≤7.5%（64%对24%；P = 0.02）或HbA≤8%（85%对53%；P = 0.02）时具有统计学意义。在第24周时，平均HbA显著降低（-0.81，标准差0.89对-0.15，标准差1.03；P = 0.03）；观察到其他心血管危险因素、药物依从性和满意度有改善趋势。
结果表明，通过家庭数字工具增强患者能力对代谢控制有潜在影响，这在COVID-19大流行期间和数字健康场景中可能更为重要。
