Using Technology to Improve Patient Outcomes in Diabetes, Hypoglycemia

Two abstracts presented at the International Conference on Advanced Technologies & Treatments for Diabetes recently highlighted the use of diabetes management technology to improve clinical outcomes.

Given the cost and impact of chronic diseases on the US health care system, health technology like digital coaching for chronic diseases is increasingly being looked at as a way to offer personalized therapies on a wide scale. According to the CDC, the total estimated cost of diabetes was $327 billion in medical costs and lost productivity. Likewise, obesity costs about $173 billion annually.

In the first study, a retrospective analysis was performed on data from DarioHealth, which is seeking to expand the use of digital health tools to manage chronic conditions, metabolic conditions, and musculoskeletal conditions.¹ The dataset included information on patients from 2019‐2022 with type 2 diabetes (T2D). Participants (n  =  712) had a starting average blood glucose (BG) >180 mg/dL and took ≥1BG measurement in the first and 12 months.

A subset of 178 users made >1 coach interaction (coach‐group); they were matched with a control group (non‐coach group), who were patients who did not have any coaching interactions (no difference in first month average BG; P  =  .454).

Researchers tested the mediation effect of the coaching on BG levels, using nonlinear regression and a nonparametric test.

The change over a year showed:

• Average BG level were significantly reduced in coach and non‐coach groups (18% vs. 11%; P  < .001).
• Overall, digital engagement mediated coaching’s impact on lowering BG (P < .001).
• A nonlinear regression analysis showed coaching interactions gradually increased measurements and improved glycemic outcomes (P < .0001) for lower engaged users (P < .0001), but for high engaged users (>36 activities, 92 measurements) coaching impact was not significant.

The second study analyzed the Dario database to compare hypoglycemia levels in older adults.²

Severe hypoglycemia can lead to falls, emergency department visits, cardiovascular events, and cognitive decline; a metric related to hypoglycemia in was added recently to the Healthcare Effectiveness Data and Information Set.

The retrospective data analysis evaluated a cohort of 2844 users of the Dario platform aged 67 or older with type 1 diabetes (T1D) or T2D. Average numbers of hypoglycemia level 1 (<70mg/dL) and level 2 (<54 mg/dL) events were observed monthly and compared with baseline.

Hypoglycemia level 1 events were lowered by 31% and 35% from baseline (0.54; 0.51 vs.0.78) on average within 6 months and sustained over a year (P <.05), respectively

Hypoglycemia level 2 events were reduced by 53% (0.08; 0.08 vs.0.17) on average within 6 months and continued over a year (P < .05). The ratio of hypoglycemia readings per total measurements were significantly reduced as well.

A subgroup analyses of 1353 patients with T1D or T2D using insulin showed a substantial reduction of severe hypoglycemia level 2 of 42% (0.11 vs.0.19) (P < .05).

Both studies show the potential of digital interventions to modify behavior changes and improve outcomes, the company said.

References

1. Fundoiano‐Hershcovitz Y, Budman S, Yaniv N, , Manejwala O. Impact of digital coaching on diabetes self‐management and glycemic outcomes for people with type 2 diabetes. Presented at: 16th International Conference on Advanced Technologies and Treatments for Diabetes (ATTD) 2023; February 22-25, 2023; Berlin, Germany. Abstract 373.

2. Fundoiano‐Hershcovitz Y, Budman S, Yaniv N, , Manejwala O. Decrease in hypoglycemia events over a year in older adults with diabetes monitoring with digital diabetes management system. Presented at: 16th International Conference on Advanced Technologies and Treatments for Diabetes (ATTD) 2023; February 22-25, 2023; Berlin, Germany. Abstract 1012.