Digital Health Tools Can Help Diabetes Patients Reduce Blood Glucose Levels

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Originally published by our sister publication Pharmacy Practice News

By Gina Shaw

Patients with type 2 diabetes can reduce their hemoglobin A1c (HbA1c) levels by up to 1.1% when they use digital health tools alongside their standard care, according to a new systematic review of 25 global, independent randomized trials of diabetes control (Front Clin Diabetes Healthc 2022;3:936752).

Patients with type 1 diabetes can reduce their HbA1c by up to 0.5%, they found, while even those with prediabetes reduced levels by a mean of 0.26%.

“These reductions are significant because every 0.1% decrease reduces the risk of retinal damage, kidney failure, ulceration and limb amputation,” said lead author Simon Leigh, PhD, the director of research for the Organisation for the Review of Health and Care Apps. “Additionally, patients with type 1 diabetes experienced a 37% reduction in microvascular complications, which can lead to blindness, [after] having reduced their blood sugar by just 1%.”

In 19 of the 25 trials that Dr. Leigh and his group reviewed, the health app was always significantly better than usual care without use of an app. “There were five that favored usual care without additional use of the health app, and one found no big difference between the two. It’s rare that you get such a heavy weighting to one side, and that’s obviously reflected in the final outcomes with those significant reductions in HbA1c.”

Nearly half the patients involved in the studies reviewed were American (1,559/3,360 patients). Among the findings:

• A Los Angeles study found that where oral therapies had failed those with uncontrolled type 2 diabetes, digital health apps helped bring medication adherence to more than 80%. Intervention participants had greater reductions in HbA1c levels, diastolic blood pressure and low-density lipoprotein cholesterol, and a higher proportion of participants at blood pressure goal at weeks 4 and 12 compared with usual care (J Med Internet Res 2017;19[7]:e246).
• A North Carolina study among veterans found that intervention participants’ HbA1c levels had improved by 1.3% versus 0.3% for usual care (P=0.050). Moreover, their systolic and diastolic blood pressure were also improved versus usual care. Based on those results, the researchers concluded that digital health apps could be a practical “real-world” way of reducing the burden of poor diabetes control (Telemed J E Health 2016;22[5]:376-384).

Unlike other reviews of digital health apps that have examined cholesterol, obesity or other measures of blood sugar, Dr. Leigh’s study focused solely on HbA1c because it is the current gold standard of glycemic control,” he said. It is the key outcome measure that predicts long-term mortality and morbidity in diabetes.”

“Put into context, the best app we found reduced HbA1c by 1.1%, which is roughly equivalent to the effect of metformin, which many people with diabetes use,” Dr. Leigh added.  “A lot of the patients in the trials will have been using metformin and still had an additional reduction of their HbA1c levels above and beyond existing care.”

Despite these promising findings, he noted, it’s important for both clinicians and patients to be aware that not all diabetes-related health apps are created equal. “There are thousands of diabetes apps out there, and fewer than 100 of them have any evidence behind them to show that they are any good,” Dr. Leigh said. “I believe the key is treating health apps, especially those for the management of a serious chronic condition like diabetes, with the same common sense and respect that you would treat medicines or devices.”