Putting Diabetes Tools 'in the Pocket' Improves A1c Control

Marlene Busko

February 27, 2020

Patients with type 2 diabetes who were part of a healthcare plan and used a computer and/or app on a mobile device to access a portal (website) with tools for managing diabetes were more adherent with prescription refills and had improved A1c levels, in a 33-month study.

The improvements were greater in patients without prior portal usage who began accessing the portal via a mobile device (smartphone or tablet) app as well as computer, as opposed to a computer only.

And the improvements were greatest in patients with poorly controlled diabetes (A1c >8%) who began accessing the portal by both means.

"Patients with greater clinical need were able to benefit even more from mobile portal access, both in taking their medications more often and in actually improving blood sugar levels," lead author Ilana Graetz, PhD, an associate professor at the Rollins School of Health Policy and Management, Emory University, Atlanta, Georgia, observed in a statement from Kaiser Permanente.

The results show that "patients can use technology to better manage their own care, their medications, and their diabetes," added senior author Mary Reed, DrPH, a research scientist at the Kaiser Permanente Division of Research, Oakland, California.

According to Reed, "This is an example of how the healthcare system, by offering patients access to their own information and the ability to manage their healthcare online, can improve their health."

"Offering this in a mobile-friendly way can give even more patients the ability to engage with their healthcare," she noted. "It literally puts the access to these tools in the patient's own pocket wherever they go."

The study was published online February 19 in JAMA Network Open

Ability to Refill Meds, Check Lab Test Results

Graetz and colleagues performed a retrospective analysis of data from 111,463 adults with type 2 diabetes who were not receiving insulin but were taking oral diabetes medications and were covered by a healthcare plan with Kaiser Permanente Northern California from April 1, 2015 to December 31, 2017.  

Patients could register online for free access to a portal that allowed them to get general health information and see their laboratory test results, as well as securely send and receive messages to and from their healthcare providers, make medical appointments, and request prescription refills.

Study outcomes were change in oral diabetes medication adherence and A1c levels at 33 months.

Patients were a mean age of 64 years and 54% were men.

At baseline, 28% had poor medication adherence (monthly days covered <80%) and 20% had poor glycemic control (A1c >8%).

After 33 months, the proportion of patients who never accessed the diabetes management portal dropped from 35% to 25%, and the proportion who accessed it from both a computer and an app increased from 34% to 62%.

Among patients with no prior portal access who began accessing the portal by computer only, medication adherence increased by 1.16% and A1c dropped by 0.06%.

However, among patients with no prior portal access who began to access it using both a computer and an app, diabetes management improvement was greater: medication adherence increased by 1.67% and A1c dropped by 0.13%.  

And among patients with no prior portal usage who had an initial A1c >8.0% and began to access the website by both means, medication adherence increased by 5.09%, equivalent to an added 1.5 medication-adherent days per month, and A1c levels fell by 0.19%.

There was also "a more modest but still statistically significant increase" of about 0.5 added medication-adherent days per month in patients with lower initial A1c levels who began accessing the portal both ways.

"While medication adherence measured by medication dispensed cannot guarantee which medications were actually used by patients," the authors write, "our findings of concurrent improvements in [A1c] levels confirm physiological improvements in diabetes control."  

"Convenient access to portal self-management tools through a mobile device could significantly improve diabetes management," they conclude.

The study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. The authors have reported no relevant financial relationships.

JAMA Netw Open. 2020;3:e1921429. Full text

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