Online tools for diabetics improve management and control

By Dr. Liji Thomas, MDFeb 19 2020

A new study published in the journal JAMA Network Open in February 2020 shows that diabetes management by patients improves significantly with their use of a mobile phone app.

Online portals for patient care that are connected to an electronic health record system have multiple advantages for patients, in that they can see their test results, order prescription refills and consult their physicians online more conveniently and in a more timely fashion. This is especially important when it comes to patients with long-term conditions, including diabetes mellitus, because it allows them to manage their illnesses with greater ease.

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The current state of the art allows online portals to be accessed via mobile phone apps, or websites optimized for mobile phone use. However, no study has yet analyzed the impact of mobile portals on self-management patient behavior, such as taking medications properly or controlling the disease condition.

Earlier research showed that patients who used these disease management tools and services only on mobile phones had a higher chance of being from a minority racial or ethnic group, to be poorer or of lower social status, and be less likely to take their medications as prescribed.

The study

The researchers looked at over 110,000 members of the health management company Kaiser Permanente in Northern California, all of whom were taking oral medications for their diabetes. None of them were on insulin. The mean age was about 64 years, with about 54% being men.

Poor diabetes management in the form of not taking medications as prescribed or not keeping blood glucose levels within normal limits impacts the patient's future health by increasing the risk of complications and other long-term illnesses. The physician and other health team staff thus have an interest in fostering self-management behavior in patients with diabetes.

The parameter of interest was the patients' use of the Kaiser online portal from 2015 to 2017. The patient portal offers services like managing prescriptions, viewing the results of tests, messaging between patients and clinicians via a secure service, booking appointments, and providing information on general health.

The study continued for 33 months.

The findings

The researchers found that the percentage of patients who made use of the patient portal via computer or mobile phone went up dramatically, from 34% to 62%. The outcomes of patient management also improved, with the highest quantum being among patients in whom the HbA1C was the highest at baseline. That is, among these patients, shifting from no portal use to the use of the online patient portal on a computer and eventually on their mobile devices was linked to an increase in following medication advice by over five percentage points. In comparison, the mean HbA1C level dropped 0.19 percentage points. If only computer access was added, medication compliance went up by about 3.5 percentage points.

In other words, the patients who needed the most management were able to reap the most significant benefit from the online portal. The reduction in HbA1C was small but could still result in substantial improvements in future health outcomes in patients with diabetes.

Overall, patients who did not use the portal and shifted to its use via computer with later mobile access as well were more faithful in adhering to the medication by 1.67 percentage points, and their HbA1C went down by 0.13 percentage points. If only computer access was added, the medication adherence went up by 1.16 percentage points.

Even for people who were already using the portal via a computer, adding mobile access is still useful in promoting better compliance with medication regimes (up by 0.50 percentage points) and lowering blood glucose levels.

Implications

Researcher Mary Reed says, "This is an example of how the health care system, by offering patients access to their own information and the ability to manage their health care online, can improve their health. Offering this in a mobile-friendly way can give even more patients the ability to engage with their health care. It literally puts access to these tools in the patient's own pocket wherever they go."

The study is vital in being the first ever to look at the association between using online tools and the effect on patient compliance with medication regime as well as objective health outcomes. Since the patients were their own controls, their behavior before beginning the use of the portal and afterward was compared to find the quantum of change. This makes the outcomes more reliable.

Moreover, in the light of earlier research, the study may suggest more extensive use of mobile apps to help patients at risk who would otherwise find it much more difficult to access appropriate levels of health care. The study concludes, "Future studies should examine how mobile portal access is associated with other types of self-management practices and care-seeking behavior."

The study is one of the latest offerings from a project that has already gone on for 10 years and was originally intended to analyze how information technology in the field of health could help health care providers to consult and help each other to ensure that the patient received better care, via the use of electronic health records.

However, the next phase of the study came to focus more on how health information technology helped patients to improve their conditions. Reed sums up the shift in study orientation over time: "In an earlier study, we found that when a physician uses an electronic health record, their patients have better control of their diabetes and have their care managed so they don't end up in the emergency room as often. And we are now also finding that patients can use technology to better manage their own care, their medications, and their diabetes."

Further exploration of this area is likely, with Reed's group pushing on to study how video telemedicine can help doctors manage patients with diabetes and how patients can manage themselves using this tool.