Effects of a Digital Patient Empowerment and Communication Tool on Metabolic Control in People With Type 2 Diabetes: The DeMpower Multicenter Ambispective Study
Bibliographic record
Abstract
BACKGROUND Diabetes is a major health care problem, reaching epidemic numbers worldwide. Reducing glycated hemoglobin (HbA1c) levels to recommended targets is associated with a marked decrease in the risk of T2DM-related complications. The implementation of new technologies, particularly telemedicine, may be helpful to facilitate self-care and empowerment of people with T2DM leading to an improved metabolic control of the disease. OBJECTIVE To analyze the effect of a home digital patient empowerment and communication tool (DeMpower App) on metabolic control in people with inadequately-controlled type 2 diabetes mellitus (T2DM). METHODS The DeMpower study was multicenter with a retrospective (observational: 52 weeks of follow-up) and prospective (interventional: 52 weeks of follow-up) design that included people with T2DM, aged ≥18 and ≤80 years, with HbA1c levels ≥7.5% to ≤9.5%, receiving treatment with non-insulin antihyperglycemic agents and able to use a smartphone App. Individuals were randomly assigned (2:1) to the DeMpower App-empowered group or control group. We describe the effect of empowerment on the proportion of patients achieving the study glycemic target, defined as HbA1c ≤7.5% with a reduction in HbA1c ≥0.5% at week 24. RESULTS Due to the COVID-19 pandemic, the study was stopped prematurely, and 50 patients (33 and 17, respectively) were analyzed. There was a trend towards a higher proportion of patients achieving the study glycemic target (46% vs 18%; P=0.07) in the DeMpower App group, that was statistically significant when the target was HbA1c ≤7.5% (64% vs 24%; P=0.02) or HbA1c ≤8.0% (85% vs 53%; P=0.02).The mean HbA1c was significantly reduced at week 24 (−0.81±0.89 vs −0.15±1.03; P=0.03) and trends for improvement of other cardiovascular risk factors, medication adherence, and satisfaction were observed. CONCLUSIONS The results suggest that patient empowerment through home digital tools has a potential effect on metabolic control, which might be even more relevant during the COVID-19 pandemic and in a digital health scenario.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".