Digital Diabetes Care System Observations from a market acceptance evaluation study in Vietnam (Preprint)

BACKGROUND Digital technologies are gaining an important role in the management of patients with diabetes. The GlucoMe solution integrates multiple aspects of diabetes care: 1) Wireless blood glucose monitor - communicates glucose data automatically to any smartphone; 2) Mobile-app - securely transmits real-time blood glucose monitor data for cloud based analyses, and enables 2-way communication between patients and health care professionals; 3) Digital diabetes clinic – analyzes and presents data to the health care professional; and 4) Control tower software provides population management reports and sends individualized alerts. OBJECTIVE Assess clinical outcomes and user satisfaction of incorporating the GlucoMe digital solution in diabetes clinics of a developing country. METHODS Five hospital endocrinology clinics in Vietnam participated in a market acceptance evaluation pilot of the GlucoMe system. The clinics sequentially recruited all patients willing to join, so long as they had a smartphone and access to internet connectivity. Patients were provided with the GlucoMe app and blood glucose monitor and instructed in their use in individual or groups sessions. The digital diabetes clinic and control tower software were installed in the clinic computers. Face-to-face visits were conducted at baseline and at 12 weeks, with monthly digital visits scheduled in the interim and additional digital visits performed as needed. HbA1c levels were measured at baseline and at 12 weeks (±20 days). Treatment modification was at the discretion of the treating physician. Outcome measures included adherence to glucose monitoring, change in glycemic parameters and patient and physician satisfaction as assessed by questionnaires. Only patients completing the pilot were included in data analyses. RESULTS The study recruited 300 patients of whom 279 patients completed the evaluation. Dropout was due to change in internet access availability (18) or death (3). Adherence to glucose measurements gradually declined, yet, at study end 81% of the patients were measuring glucose at least once a week. Digital contact from the health care professional to the patient or vice-versa (excluding automated alerts) occurred in average every 6.2 days. Average glucose levels declined from 170.4±64.6 mg/dl in the first two weeks to 150.8±53.2 mg/dl in the last two weeks (P<0.001) (n=221). HbA1c levels at baseline and 12 weeks were available for only 126 of the patients and declined from 8.3±1.9% to 7.6±1.3 (P<0.001). Over 95% of the physicians and patients stated they would strongly support the broad usage of the GlucoMe platform in diabetes clinics across the country. CONCLUSIONS The GlucoMe digital solution was broadly accepted by both patients and health care professionals and improved glycemic outcomes. The digital platform yielded increased number of patient-health care professional interactions, yet of short duration, enabling judicious allocation of limited time resources. The durability, scalability and cost-effectiveness of this approach merit further study.