An mHealth Diabetes Intervention for Glucose Control


Posted Jul 26 , 2019 01:41 AM

An mHealth Diabetes Intervention for Glucose Control: Health Care Utilization Analysis.
Quinn CC, et al. JMIR Mhealth Uhealth 2018;online October 15.

Institute Summary (excerpted from the abstract)

Type 2 diabetes (T2D) is a major chronic condition requiring management through lifestyle changes and recommended health service visits. Mobile health (mHealth) is a promising tool to encourage self-management, but few studies have investigated the impact of mHealth on health care utilization. The objective of this analysis was to determine the change in 2-year health service utilization and whether utilization explained a 1.9% absolute decrease in glycated hemoglobin (HbA1c) over 1-year in the Mobile Diabetes Intervention Study (MDIS). The authors used commercial claims data from 2006 to 2010 linked to enrolled patients’ medical chart data in 26 primary care practices in Maryland, USA. Secondary claims data analyses were available for 56% (92/163) of participants. In the primary MDIS study, physician practices were recruited and randomized to usual care and 1 of 3 increasingly complex interventions. Patients followed physician randomization assignment. The main variables in the analysis included health service utilization by type of service and change in HbA1c. The claims data was aggregated into 12 categories of utilization to assess change in 2-year health service usage, comparing rates of usage pre- and post-trial. The authors also examined whether utilization explained the 1.9% decrease in HbA1c over 1 year in the MDIS cluster randomized clinical trial. A significant group by time effect was observed in physician office visits, general practitioner visits, other outpatient services, prescription medications, and podiatrist visits. Physician office visits (P=.01) and general practitioner visits (P=.02) both decreased for all intervention groups during the study period, whereas prescription claims (P<.001) increased. The frequency of other outpatient services (P=.001) and podiatrist visits (P=.04) decreased for the control group and least complex intervention group but increased for the 2 most complex intervention groups. No significant effects of utilization were observed to explain the clinically significant change in HbA1c.

Why is this important?

Studies investigating web-based interventions to promote T2D self-management are inconclusive or demonstrate only moderate effects. Few randomized studies demonstrate even moderate effects that include interventions maintaining behavior >6 months, or include older adults or minorities. The analysis reported in this study involve a cluster randomized controlled trial (c-RCT) of a 1-year mobile phone intervention previously described (Quinn CC, et al. Diabetes Care 2011;34:1934-1942). No significant effects of utilization were observed to explain the clinically significant change in HbA1c. Claims data analyses identified patterns of utilization relevant to mHealth interventions. It is likely that the mobile phone based, personalized behavioral intervention resulted in greater monitoring in-between health service visits and therefor impacted utilization and monitoring over the 1-year period. Findings may encourage patients and health providers to discuss the utilization of treatment-recommended services, lab tests, and prescribed medications. Have you used mobile health interventions of any kind in your practice? Do patients who use mHealth interventions do better in your experience?

Concluding Thought: Digital interventions can help!

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