Liverpool — Personalised care plans combining both an in-person and digital approach led to a reduction in blood glucose levels and body mass index (BMI) over a 6-month period in people with type 2 diabetes, according to a real-world, prospective randomised controlled trial (RCT) conducted in primary care.
Dr Adrian Heald, consultant physician in diabetes and endocrinology at Salford Royal Hospital presented the findings as a poster at this year's Diabetes UK Professional Conference (DUKPC).
"Around 30% of patients with type 2 diabetes are uncontrolled with pharmacological therapies, so one way to improve their glucose control is to provide ongoing advice and digital prompts [via an app on a mobile phone] and support," he explained. The study "dovetailed this with a personalised care plan, developed by the patient and clinician, which effectively becomes an add-on to usual care."
Effectiveness of Collaborative Care Planning Software
The study assessed the effectiveness of collaborative care planning software developed by AI-powered patient software company Healum in 13 UK GP practices . Dr Heald pointed out the uniqueness of both the app content and how it was integrated with the existing primary care system. "The personalised care plan was created within the Healum software, and this sat within the GP's operating system. It was then mirrored onto the patient's phone [via the app], and the app provided patients with goals, recommendations and reflections, as well as access to resources relevant to their individual care plan, for example, a link to a local walking group if they wanted to get out more."
Combining a personalised care plan with a patient-management mobile app resulted in a higher proportion of participants with a significant reduction in HbA1c and BMI, as well as a greater improvement in quality of life compared with those people who received usual care without the digital app.
"Also, practice nurses delivered the intervention in an everyday practice setting, without requiring additional resources or specialist courses," said Dr Heald, highlighting its real-world value.
Sister Erin Gillingham, a practice nurse at Park Lane Surgery at the Waters Green Medical Centre in Macclesfield and member of the study team, told Medscape News UK that patients engaging with the management app achieved great results with decreasing HbA1c levels and weight loss, compared with more traditional diabetes monitoring methods. "It enabled them to take control of their own health needs, [with goals] that they set by themselves, and gave them something to focus on that was tangible. It's a great way to empower patients to reach their own health goals."
People living with type 2 diabetes having an HbA1c of greater than 58 mmol/mol were drawn from across three surgeries in southern England plus 10 surgeries in Eastern Cheshire.
They were randomised to either a personalised care plan combined with a patient management mobile app (active group; n=115) or a control group that received usual type 2 diabetes care, (usual care, n=82).
Each person's personalised care plan was created with a healthcare professional and worked in tandem with the app. Patients received the care plans and any recommendations, such as daily lifestyle prompts, and were offered access to a range of online resources via the Healum Collaborative Care Planning Software and Self-Planning management app for 6 months.
Data on patient self-rated quality of life (as measured by the EQ-5D-5L and EQ VAS, both standardised measures of health-related quality of life), as well as HbA1c and BMI were monitored over the study period, with changes noted.
The majority of participants were men (58.9%) with 33% women (8.1% did not report sex), and the average age was 61.1 years (range 22–85) in the intervention group and 65.2 years (range 34–85) in the control group. Some data were excluded from the analysis due to incomplete reporting, so eventually 65 participants in the control group contributed HbA1c data, and 56 contributed BMI data; while in the treatment group, 87 contributed HbA1c data and 74 contributed BMI data.
72.4% Reduced HbA1c Over the 6 Months
In the active treatment group, 72.4% reduced their HbA1c over the 6 months, compared with 41.5% of the control group, while 52.7% of the active treatment group reduced their BMI compared with 42.9% for the control group.
Regarding the percentage change in HbA1c, the active treatment group lowered their HbA1c by a mean of 7.4% over 6 months, compared with an increase of 1.8% for the control group (p<0.01). For BMI, the average percentage change in the treatment group was -0.7%%, compared with -0.2% for the control group (p<0.037).
Quality of life showed that the average EQ VAS score increased pre- to post-trial for the active treatment group, on average by 8.2%, but decreased by an average of 2.8% for the control group. "There was a marked improvement in quality of life in those participants using the personalised care plan and app," said Dr Heald.
Reena Patel, a specialist nurse in diabetes, who was not associated with the study, welcomed the software and the research. "This digital tool appears to be cost-effective [and] efficient, without compromising the quality of care," she remarked. "It allows a sustainable, holistic approach and care delivery within primary care, using the multidisciplinary teams model." Although this RCT used an English version of the app, there is no reason why it cannot be adapted for other languages.
Jonathan Abraham, CEO and founder of Healum, said: "The solution was co-created by patients and healthcare professionals with the aim of solving the problems that people face when trying to manage their diabetes in the thousands of hours when they are not in front of their clinicians."
Dr Heald received some funding from Healum. Ms Gillingham has declared no relevant conflicts. Ms Patel has also declared no conflicts. The study received some funding from Innovate UK.