App Engagement Data From Patients With Diabetes

Elizabeth Holt, MD, FACE: They also looked at how people engaged with the app. They describe that engagement in terms of number of sessions per week on the app and in terms of number of minutes per week spent on the app. When looking at that data, what strikes me is a classic dose-response relationship between more app engagement leading to improving glycemic metrics. Dr Miller, what stands out to you from the engagement data?

Eden Miller, DO: I always want to look at how much effort somebody has to put in to get benefit and the first thing I noticed is that all persons benefited, irrespective of the engagement. That’s the key. You did see an incremental increase and some of the datasets flatten out over time that we see. You head into the diabetes distress, what we call the “neurotic glucose monitoring,” which really doesn’t help you much. I like to look at it as if even those individuals who don’t have a high level of engagement are going to benefit. There definitely is a sweet spot. We see through the data there’s a sweet spot and I explain that to patients. Here’s the sweet spot that occurs and this is the amount of time or engagements. That’s nice because it’s not something that, in order to be successful, they have to be highly engaged in. Yes, we do see an increase in performance at any level of engagement. It happens with all forms of technology. I like that there’s at least this baseline benefit, even at what we would call the lower engaged individuals and that I can give them some advice. If they look at this just 1 more time per week, they might be benefiting a little bit from that.

Elizabeth Holt, MD, FACE: What do you think that means for an endocrinologist as opposed to a primary care physician?

Eden Miller, DO: That’s an interesting concept. For me, living in the world of family practice and diabetology, I do have a different viewpoint on different things. I might think, to be honest with you, that some of my endocrinology friends might be slightly skeptical of whether this particular app can help them and I think this data’s going to be quite compelling. Here’s the reason why: because you’re handing over some of the opportunity to the individual. It’s that disease ownership with ease that we’re looking for. You can’t have the endocrinologist or the primary care doctor there all the time. I think the endocrinologists are going to be pretty compelled by the data. For primary care physicians, it is the data acquisition. It might be a different perspective because not a lot of them are looking at data or they don’t know what to do with it. Endocrinology is pretty quick at accepting a lot of those data things, so I think they’ll be amazed at SMBG [self-monitoring of blood glucose] giving us this kind of data. I think for primary care, it’s going to be that this is a way that you can start engaging in data that you are not familiar with doing and it’s easy for the patient and it’s easy for you, as a primary care provider.

Elizabeth Holt, MD, FACE: Dr Miller, when we look at the data, we see in people with type 2 diabetes that improvements in their blood glucose levels were noted. Even in those who engaged in fewer than 1 session per week on average, they showed substantial improvements in their mean glucose reducing by 14.2 mg/dL, their readings and range increasing by 8.6 percentage points, and their hyperglycemic readings reducing by 8.7 percentage points. Are those meaningful reductions and improvements?

Eden Miller, DO: I think those are very meaningful, even given the time. You said once a week. Once a week, when a person engages in this application, they’re going to improve 8%. Totally worth it. Those are good numbers because that really says even at what I would consider a minimal engagement in the application, we’re seeing benefit. As we explore some of the data, it would really be helpful to figure out what that sweet spot is. We know we’re going to get better, even with minimal engagement, but what level of engagement for that individual is ideal to get them the maximum benefit? That’s going to vary by the person, but I also think that no matter what level of engagement we are going to see improvement.

Transcript edited for clarity