Role of Digital Engagement in Diabetes Care Beyond Measurement: Retrospective Cohort Study

Background The use of remote data capture for monitoring blood glucose and supporting digital apps is becoming the norm in diabetes care. One common goal of such apps is to increase user awareness and engagement with their day-to-day health-related behaviors (digital engagement) in order to improve diabetes outcomes. However, we lack a deep understanding of the complicated association between digital engagement and diabetes outcomes. Objective This study investigated the association between digital engagement (operationalized as tagging of behaviors alongside glucose measurements) and the monthly average blood glucose level in persons with type 2 diabetes during the first year of managing their diabetes with a digital chronic disease management platform. We hypothesize that during the first 6 months, blood glucose levels will drop faster and further in patients with increased digital engagement and that difference in outcomes will persist for the remainder of the year. Finally, we hypothesize that disaggregated between- and within-person variabilities in digital engagement will predict individual-level changes in blood glucose levels. Methods This retrospective real-world analysis followed 998 people with type 2 diabetes who regularly tracked their blood glucose levels with the Dario digital therapeutics platform for chronic diseases. Subjects included “nontaggers” (users who rarely or never used app features to notice and track mealtime, food, exercise, mood, and location, n=585) and “taggers” (users who used these features, n=413) representing increased digital engagement. Within- and between-person variabilities in tagging behavior were disaggregated to reveal the association between tagging behavior and blood glucose levels. The associations between an individual’s tagging behavior in a given month and the monthly average blood glucose level in the following month were analyzed for quasicausal effects. A generalized mixed piecewise statistical framework was applied throughout. Results Analysis revealed significant improvement in the monthly average blood glucose level during the first 6 months (t=−10.01, P<.001), which was maintained during the following 6 months (t=−1.54, P=.12). Moreover, taggers demonstrated a significantly steeper improvement in the initial period relative to nontaggers (t=2.15, P=.03). Additional findings included a within-user quasicausal nonlinear link between tagging behavior and glucose control improvement with a 1-month lag. More specifically, increased tagging behavior in any given month resulted in a 43% improvement in glucose levels in the next month up to a person-specific average in tagging intensity (t=−11.02, P<.001). Above that within-person mean level of digital engagement, glucose levels remained stable but did not show additional improvement with increased tagging (t=0.82, P=.41). When assessed alongside within-person effects, between-person changes in tagging behavior were not associated with changes in monthly average glucose levels (t=1.30, P=.20). Conclusions This study sheds light on the source of the association between user engagement with a diabetes tracking app and the clinical condition, highlighting the importance of within-person changes versus between-person differences. Our findings underscore the need for and provide a basis for a personalized approach to digital health.

Tagging Items Automatically Based on Both Content Information and Browsing Behaviors

Tags have been adopted by many online services as a method to manage their online resources. Effective tagging benefits both users and firms. In real applications providing a user tagging mechanism, only a small portion of tags are usually provided by users. Therefore, an automatic tagging method, which can assign tags to different items automatically, is urgently needed. Previous works on automatic tagging focus on exploring the tagging behavior of users or the content information of items. In online service platforms, users frequently browse items related to their interests, which implies users’ judgment about the underlying features of items and is helpful for automatic tagging. Browsing-behavior records are much more plentiful compared with tagging behavior and easy to collect. However, existing studies about automatic tagging ignore this kind of information. To properly integrate both browsing behaviors and content information for automatic tagging, we propose a novel probabilistic graphical model and develop a new algorithm for the model parameter inference. We conduct thorough experiments on a real-world data set to evaluate and analyze the performance of our proposed method. The experimental results demonstrate that our approach achieves better performance than state-of-the-art automatic tagging methods. Summary of Contribution. In this paper, we study how to automatically assign tags to items in an e-commerce background. Our study is about how to perform item tagging for e-commerce and other online service providers so that consumers can easily find what they need and firms can manage their resources effectively. Specifically, we study if consumer browsing behavior can be utilized to perform the tagging task automatically, which can save efforts of both firms and consumers. Additionally, we transform the problem into how to find the most proper tags for items and propose a novel probabilistic graphical model to model the generation process of tags. Finally, we develop a variational inference algorithm to learn the model parameters, and the model shows superior performance over competing benchmark models. We believe this study contributes to machine learning techniques.

Role of Digital Engagement in Diabetes Care Beyond Measurement: Retrospective Cohort Study (Preprint)

BACKGROUND The use of remote data capture for monitoring blood glucose and supporting digital apps is becoming the norm in diabetes care. One common goal of such apps is to increase user awareness and engagement with their day-to-day health-related behaviors (digital engagement) in order to improve diabetes outcomes. However, we lack a deep understanding of the complicated association between digital engagement and diabetes outcomes. OBJECTIVE This study investigated the association between digital engagement (operationalized as tagging of behaviors alongside glucose measurements) and the monthly average blood glucose level in persons with type 2 diabetes during the first year of managing their diabetes with a digital chronic disease management platform. We hypothesize that during the first 6 months, blood glucose levels will drop faster and further in patients with increased digital engagement and that difference in outcomes will persist for the remainder of the year. Finally, we hypothesize that disaggregated between- and within-person variabilities in digital engagement will predict individual-level changes in blood glucose levels. METHODS This retrospective real-world analysis followed 998 people with type 2 diabetes who regularly tracked their blood glucose levels with the Dario digital therapeutics platform for chronic diseases. Subjects included “nontaggers” (users who rarely or never used app features to notice and track mealtime, food, exercise, mood, and location, n=585) and “taggers” (users who used these features, n=413) representing increased digital engagement. Within- and between-person variabilities in tagging behavior were disaggregated to reveal the association between tagging behavior and blood glucose levels. The associations between an individual’s tagging behavior in a given month and the monthly average blood glucose level in the following month were analyzed for quasicausal effects. A generalized mixed piecewise statistical framework was applied throughout. RESULTS Analysis revealed significant improvement in the monthly average blood glucose level during the first 6 months (<i>t</i>=−10.01, <i>P</i>&lt;.001), which was maintained during the following 6 months (<i>t</i>=−1.54, <i>P</i>=.12). Moreover, taggers demonstrated a significantly steeper improvement in the initial period relative to nontaggers (<i>t</i>=2.15, <i>P</i>=.03). Additional findings included a within-user quasicausal nonlinear link between tagging behavior and glucose control improvement with a 1-month lag. More specifically, increased tagging behavior in any given month resulted in a 43% improvement in glucose levels in the next month up to a person-specific average in tagging intensity (<i>t</i>=−11.02, <i>P</i>&lt;.001). Above that within-person mean level of digital engagement, glucose levels remained stable but did not show additional improvement with increased tagging (<i>t</i>=0.82, <i>P</i>=.41). When assessed alongside within-person effects, between-person changes in tagging behavior were not associated with changes in monthly average glucose levels (<i>t</i>=1.30, <i>P</i>=.20). CONCLUSIONS This study sheds light on the source of the association between user engagement with a diabetes tracking app and the clinical condition, highlighting the importance of within-person changes versus between-person differences. Our findings underscore the need for and provide a basis for a personalized approach to digital health.