Efficacy of Personalized Diabetes Self-care Using an Electronic Medical Record–Integrated Mobile App in Patients With Type 2 Diabetes: 6-Month Randomized Controlled Trial
Open accessAbstract
Background: A system that combines technology and web-based coaching can help treat chronic conditions such as diabetes. However, the effectiveness of apps in mobile health (mHealth) interventions is inconclusive and unclear due to heterogeneous interventions and varying follow-up durations. In addition, randomized controlled trial data are limited, and long-term follow-up is lacking, especially for apps integrated into electronic medical records. Objective: We aimed to assess the effect of an electronic medical record–integrated mobile app for personalized diabetes self-care, focusing on the self-monitoring of blood glucose and lifestyle modifications, on glycemic control in patients with type 2 diabetes mellitus. Methods: In a 26-week, 3-arm, randomized, controlled, open-label, parallel group trial, patients with type 2 diabetes mellitus and a hemoglobin A1c (HbA1c) level of ≥7.5% were recruited. The mHealth intervention consisted of self-monitoring of blood glucose with the automatic transfer of glucose, diet, and physical activity counseling data (iCareD system). Participants were randomly assigned to the following three groups: usual care (UC), mobile diabetes self-care (MC), and MC with personalized, bidirectional feedback from physicians (MPC). The primary outcome was the change in HbA1c levels at 26 weeks. In addition, diabetes-related self-efficacy, self-care activities, and satisfaction with the iCareD system were assessed after the intervention. Results: A total of 269 participants were enrolled, and 234 patients (86.9%) remained in the study at 26 weeks. At 12 weeks after the intervention, the mean decline in HbA1c levels was significantly different among the 3 groups (UC vs MC vs MPC: −0.49% vs −0.86% vs −1.04%; P=.02). The HbA1c level decreased in all groups; however, it did not differ among groups after 26 weeks. In a subgroup analysis, HbA1c levels showed a statistically significant decrease after the intervention in the MPC group compared with the change in the UC or MC group, especially in patients aged <65 years (P=.02), patients with a diabetes duration of ≥10 years (P=.02), patients with a BMI of ≥25.0 kg/m2 (P=.004), patients with a C-peptide level of ≥0.6 ng/mL (P=.008), and patients who did not undergo treatment with insulin (P=.004) at 12 weeks. A total of 87.2% (137/157) of the participants were satisfied with the iCareD system. Conclusions: The mHealth intervention for diabetes self-care showed short-term efficacy in glycemic control, and the effect decreased over time. The participants were comfortable with using the iCareD system and exhibited high adherence. Trial Registration: Clinical Research Information Service, Republic of Korea KCT0004128; https://tinyurl.com/bdd6pa9m
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A total of 47 studies reported data on the change in HbA1c levels between groups following telemedicine interventions, with 4 studies including 2 types of telemedicine.
“A total of 47 studies [25-71] reported data on the change in HbA1c levels between groups following telemedicine interventions, with 4 [26-29] studies including 2 types of telemedicine.”
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- Authors
- Lee, E. Y., Cha, S.-A., Yun, J.-S., Lim, S.-Y., Lee, J.-H., Ahn, Y.-B., Yoon, K.-H., Hyun, M. K., & Ko, S.-H.
- Affiliations
- The Catholic University of Korea Seoul St. Mary's Hospital (KR)
- Wonkwang University Sanbon Hospital (KR)
- The Catholic University of Korea St. Vincent's Hospital (KR)
- Catholic University of Korea (KR)
- Dongguk University WISE (KR)
- Corresponding author
- Ko, Seung-Hyun
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2022-07-28
- Volume
- 24
- Issue
- 7
- Pages
- e37430
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC9496112
- OpenAlex
- W4288719290
- Cited by
- 83
- References
- 42
- Citations by year
- 2026: 24 · 2025: 29 · 2024: 17 · 2023: 12 · 2022: 1
- FWCI
- 16.94
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Korea Health Industry Development Institute (HI19C0784)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, mobile health, diabetes self-care, electronic health record integration, personalized feedback, physician feedback, glycemic control, HbA1c, self-monitoring of blood glucose, diabetes self-efficacy, lifestyle modification, older adults, C-peptide, physical activity counseling, nutrition counseling, user satisfaction, long-term follow-up
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Type 2, Humans, Self Care, Electronic Health Records, Mobile Applications
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