Background: The efficacy of digital technology in improving diabetes management has typically been demonstrated through studies such as randomized controlled trials, which have reported a steeper reduction in hemoglobin A1c (HbA1c) values for patients who adopted a digital solution. However, evidence from real-world clinical practice is still limited. Objective: This study aimed to evaluate the effectiveness of digital interventions by tracking HbA1c improvements over 1 year in real-world clinical settings. Methods: Patients used the Health2Sync mobile app to track self-measured outcomes and communicate with health care professionals (HCPs). HCPs used the web-based Patient Management Platform to monitor patient data, view test results from clinical laboratories, and communicate with patients. Patients who have been onboarded for at least 13 months and have consecutive HbA1c findings for 5 quarters were included in the analysis. They were then stratified into 3 groups (high, mid, and low retention) based on their level of use of Health2Sync in the first 6 months of onboarding. A mixed model was built to compare the slopes of the rate of reduction in HbA1c among the groups. In addition, these patients’ retention on the app from the seventh to the 12th month was verified through multiple comparisons. Results: A sample of 2036 users was included in the analysis. With the mixed model coefficient estimates, we found that app users had significant HbA1c percentage reductions as the passed quarter count increased (t=–9.869; P<.001), and that effectiveness increased in the high (t=–5.173) and mid retention (t=–6.620) groups as the interaction effects were significantly negative compared to that in the low retention group (P<.001) in the passed quarter count. The low retention group also had the highest average HbA1c value at the end of 13 months (high: 7.01%, SD 1.02%; mid: 6.99%, SD 1.00%; low: 7.17%, SD 1.14%) (Bonferroni correction: high vs low, P=.07; mid vs low, P=.02; high vs mid, P>.99). The level of use of the app remained consistent in the seventh to the 12th month after onboarding (high: 5.23 [SD 1.37] months, mid: 2.43 [SD 1.68] months, low: 0.41 [SD 0.97] months) (P<.001). Conclusions: Our analysis shows that continuous usage of the diabetes management app is associated with better glycemic control in real-world clinical practice. Further studies are required to reveal the efficacy for specific diabetes types and to observe effects beyond 1 year.

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中文翻译：

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实际临床实践中持续使用糖尿病管理应用程序对血糖控制的影响：回顾性分析

背景：数字技术在改善糖尿病管理方面的功效通常通过随机对照试验等研究得到证明，这些研究报告称，对于采用数字解决方案的患者，血红蛋白 A1c (HbA1c) 值的降低幅度更大。然而，来自真实世界临床实践的证据仍然有限。目标：本研究旨在通过跟踪真实临床环境中 1 年以上 HbA1c 的改善来评估数字干预的有效性。方法：患者使用 Health2Sync 移动应用程序来跟踪自我测量的结果并与医疗保健专业人员 (HCP) 进行交流。HCP 使用基于 Web 的患者管理平台来监控患者数据、查看临床实验室的测试结果并与患者沟通。已入职至少 13 个月且连续 5 个季度出现 HbA1c 检测结果的患者被纳入分析。然后根据他们在入职的前 6 个月内使用 Health2Sync 的水平将他们分为 3 组（高、中和低留存率）。建立了一个混合模型来比较各组之间 HbA1c 降低率的斜率。此外，这些患者从第 7 个月到第 12 个月对应用程序的保留情况通过多重比较得到验证。结果：分析中包含了 2036 名用户的样本。通过混合模型系数估计，我们发现应用程序用户的 HbA1c 百分比随着通过季度计数的增加而显着降低 (t=–9.869; P<.001)，并且有效性在高 (t=–5.173) 和中期增加保留（t=–6。620) 组，因为在通过的四分之一计数中，与低保留组 (P<.001) 相比，交互作用显着为负。低保留组在 13 个月末的平均 HbA1c 值也最高（高：7.01%，SD 1.02%；中：6.99%，SD 1.00%；低：7.17%，SD 1.14%）（Bonferroni 校正：高与低，P=.07；中与低，P=.02；高与中，P>.99）。应用程序的使用水平在入职后的第 7 个月到第 12 个月保持一致（高：5.23 [SD 1.37] 个月，中：2.43 [SD 1.68] 个月，低：0.41 [SD 0.97] 个月）（P<. 001）。结论：我们的分析表明，在实际临床实践中，持续使用糖尿病管理应用程序与更好的血糖控制相关。

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