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Telehealth, Smartphones, Mobile Apps and CGM: Changing The Way We Control Type 2 Diabetes In Adults

Oct 20, 2020
 
Editor: Steve Freed, R.PH., CDE

Author: Tarshay Boyd, PharmD. Candidate, LECOM School of Pharmacy

Can a virtual diabetes clinic (VDC) improve diabetes care? 

Type 2 diabetes, as we know, is one of the most common disorders seen in the world.  Many people suffer from controlling their blood glucose and HbA1c levels. Onduo, a virtual diabetes clinic (VDC), conducted a study to improve glycemic control, HbA1c, and other comorbidities affected by diabetes.  The study’s purpose was to combine the following technologies: mobile app, virtual personal lifestyle coach, connected devices, live video sessions, and real-time continuous glucose monitoring (RT-CGM) tool. The study evaluated patients with type 2 diabetes to measure their glycemic outcomes over four months. 

 

Prior studies concluded a 52-week, two-arm, randomized controlled trial (RCT); they used intermittent RT-CGM compared to self-blood glucose monitoring.  There was a reduction seen in HbA1c at 1% in the RT-CGM group.  Similar studies, such as a retrospective study of 740 VDC participants, showed a decline of 1.5% in HbA1c.   

The Onduo study was a prospective single-arm evaluating glycemic outcomes of participants from the Onduo VDC for a total of 4 months. The patients were required to be equal to or greater than 18 years old, presenting with type 2 diabetes. Participants had to have HbA1c levels between 8.0-12.0%. The study used two facilities from February 2019 to October 2019. The primary outcome was the change in HbA1c in the four months. Secondary endpoints were changes in weight and RT-CGM glycemic metrics. They also monitored changes in lipids and blood pressure during the four months of evaluation. Each participant received an RT-CGM device to use during the study. They had to wear six of the 10-day sensors during the study time.  The participants also had access to live endocrinologists and lifestyle coaches.  

The study was power at 90%; to perceive a 0.5% decline in HbA1c at the four months; using a 2-sided test. A paired t-test evaluated primary and secondary outcomes. Wilcoxon signed-rank test was used to evaluate <70 mg/dL and > 250 mg/dL.  The author reported P-values as statistically significant.   

Fifty-five people out of sixty completed the study. The average age was 57, with about 22 of the participants females. The primary outcome of change in HbA1c decreased by 1.6% with a standard deviation (SD) 1%; P-value <0.001; a decrease from 8.9% to 7.3% (SD 0.9%) at the 4 months evaluation. Participants with baseline HbA1c 8.0% to 9.0% showed a decrease by 1.2% (SD 0.6%), and for participants with baseline HbA1c > 9.0%, the decline was at 2.4% (SD 1.3%). Both are reporting a P-value of <0.001. 

Participants wore the RT-CGM devices for four months. The mean glucose level at baseline at follow-up: 169.2 (SD 29.3) compared to follow-up results decline seen at 154.6 (SD 33.0). The authors reported an increase in the current time range of 70 to 80 mg/dL, the same as the mean increased seen at 2.4 hours’ time in range (TIR).  There was a significant decrease in weight, body mass index (BMI), systolic blood pressure (PB), total cholesterol, LDL cholesterol, the ratio of total cholesterol/HDL, and triglycerides, all showing P-values between 0.04 to < 0.001.   

The outcome of this study proves that with telehealth, smartphone, mobile app, and continuous glucose monitor devices, patients can see a reduction in their HbA1c, blood glucose along with weight, BMI, PB, and cholesterol levels.  During the four-month period, participants were able to see significant glycemic control of their type 2 diabetes.  This study is of interest because many suffer from this disease and need assistance and guidance to better control their glucose levels. Future studies need to include a larger sample size in population and longer duration to analyze remote controls’ outcome. The study limitations were sample size, not randomized with control, and time.  

Practice Pearls: 

  • Lifestyle modifications in diet, exercise, and blood glucose monitoring are key factors to control type 2 diabetes. 
  • Virtual clinics with remote telehealth, lifestyle coaches, and monitoring devices are the future for controlling type 2 diabetes. 
  • Reducing patient weight, lowering blood pressure, and lipids help the patient with glycemic control.  

 

J Med Internet Res. 2020 Aug 28;22(8):e21778 

 

Tarshay Boyd, PharmD. Candidate, LECOM School of Pharmacy