Introduction and Objective: To evaluate whether higher engagement with a digital diabetes self-management and education support (DSMES) program + continuous glucose monitoring (CGM) integrated solution is associated with better clinical outcomes through a secondary analysis of a randomized controlled trial.Methods: Participants with type 2 diabetes and HbA1c ≥ 8% not using mealtime bolus insulin (26-83 years old; mean HbA1c: 9.58%) were randomly assigned to and enrolled in a digital DSMES + CGM integrated solution (n=42) or usual care (n=49) for 6 months. The current analysis only includes participants in the digital DSMES + CGM condition. A standardized total engagement score was calculated based on the sum of the total number of interactions with app features (e.g., meals tracked, lessons completed). Outcomes included HbA1c and CGM-derived glycemic measures, including glucose management indicator (GMI), mean daily glucose, and % time in range (TIR 70-180 mg/dL), above range (TAR > 180 mg/dL), and below range (TBR < 70 mg/dL).Results: Utilizing a linear mixed effect model controlling for number of weeks enrolled in the digital DSMES + CGM condition, participants with mean levels of total engagement experienced a 1.08% decrease in HbA1c (p <.001) and a 16.63% decrease in TAR (p =.002), as well as a 16.54% increase in TIR (p =.001), from baseline to 6 months. Participants with higher levels (+1 SD) of total engagement experienced a 1.71% decrease in HbA1c (p <.001), a 1.37% decrease in GMI (p <.001), a 32.92% decrease in TAR (p <.001), a 56.41 mg/dL decrease in mean daily glucose (p <.001), and a 32.86% increase in TIR (p <.001) from baseline to 6 months. Participants with lower levels (-1 SD) of engagement experienced no significant changes in HbA1c, TIR, TAR, GMI, or mean daily glucose from baseline to 6 months (all p >.05).Conclusion: Participants with greater engagement in digital DSMES programs that integrate continuous CGM may see improved long-term diabetes management.
J.B. Naqvi: Employee; Omada Health. Other Relationship; Abbott. J. Napoleone: Employee; Omada Health. Other Relationship; Abbott. S. Zion: Employee; Omada Health. Other Relationship; Abbott. Employee; Gilead Sciences, Inc. A. Berthoumieux: Employee; Omada Health, Inc. Other Relationship; Abbott. H. Lee: Employee; Abbott. Other Relationship; Omada Health. T. Dunn: Employee; Abbott. Other Relationship; Omada Health. C.B. Jasik: None. S. Linke: Employee; Omada Health.
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