Effectiveness evaluation of the mobile health patients management mode on treatment compliance and glycemic control for type 2 diabetes patients using basal insulin treatment for 12 weeks

Objective To assess the effectiveness of a novel mobile health patient management system involving doctors, nurses, and patients( TRIO mode)on glycemic control and self-monitoring of blood glucose(SMBG)compliance among the type 2 diabetes mellitus(T2DM)patients using basal insulin standardization treatment in China. Methods From April 2014 to April 2015, 416 hospitals in 110 cities of 30 provinces, municipalities, and autonomous regions across China were selected to participate in the program. A Online-to-Offline(O2O)integrated mobile health patients management system with mobile terminals for the doctors, nurses, and patients was applied in the program for patient education, follow-up, and data collection. For all the newly recruited patients, the baseline information was collected and a first-day patient education program were provided by a designated nurse. In the 12-week follow-up period, data of basal insulin doses and fasting plasma glucose(FPG)values were collected from the patients by text messages or tracking phone call by the nurse. The patients also received timely standardized patients health education and glycemic control guidance by participating in the patient education forum and doctors′ in order to help them achieve the glycemic control goals. Results A total of 102 524 patients using basal insulin treatment were eligible and enrolled in the program. 64 420 patients completed the 12 weeks follow-up and provided at least one FPG value at all five follow-ups. In total, 62.6%(40 334/64 420)of the patients reached the FPG control target(FPG≤7.0 mmol/L)at the end of follow-up period. The weekly average FPG for patients with complete SMBG data decreased from 10.58 mmol/L to 6.91 mmol/L while the FPG control rates increased from 13.4% to 69.2%. The weekly average FPG for the patients provided incomplete SMBG data decreased from 10.54 mmol/L to 7.13 mmol/L while the FPG control rates increased from 13.6% to 62.2%. The FPG control rates for the patients provided complete SMBG were 1.74 times higher than those patients provided incomplete SMBG. Based on a GEE model, the average decline of the FPG and the increase of the FPG control rates were significantly better for patients who provided complete SMBG as compared to the patients with incomplete SMBG data. The results of the multivariate logistic regression analysis showed that factors such as receiving the first-day education, participating in the follow-up patient education forum, and the doctors′ hotline were significantly associated with the improvement of the SMBG compliance, the treatment adherence, and the FPG control rates. The SMBG compliance and the treatment adherence for patients who completed first-day education were 1.68 times and 1.22 times higher, respectively. For the patients who participated in follow-up education activities, their SMBG compliance and treatment adherence were 3.17 times and 3.36 times higher, respectively. Conclusion The innovative TRIO mobile health patient management mode was feasible and effective for better managing the type 2 diabetes patients initiated on basal insulin treatment in China. Active participation in the first-day education program and the follow-up patient education activities can effectively improve the SMBG compliance and the treatment adherence, and therefore play an important role in helping patient achieving FPG control in a faster manner. (Chin J Endocrinol Metab, 2016, 32: 639-646) Key words: Diabetes mellitus, type 2; Mobile health; Basal insulin; Fasting plasma glucose; Glycemic control