Heterogeneity of effects of a mobile health disease management programme on glycaemic control
Ryo Shiraishi, Takahiro Miki, Shinpei Ishida, Masashi Kanai, Yuta Hagiwara, Takaaki IkedaBackground
Whether mobile health (mHealth) interventions positively influence glycaemic control remains unclear. This study aimed to identify heterogeneity in the effects of mHealth-based disease management programmes on glycaemic control over a 1-year follow-up period within a target trial emulation framework.
Methods
The study included participants diagnosed with hypertension, diabetes or dyslipidaemia between June 2021 and December 2023 who were either receiving medication or had a history of coronary artery disease or stroke and had a haemoglobin A1c (HbA1c) level of ≥ 7.0%. Hypothetical treatment regimens involve mobile health-based disease management combined with conventional treatment or conventional treatment alone. The primary outcome of this study was poor glycaemic control, operationally defined as a HbA1c level of ≥ 7.0% sustained over a 1-year follow-up period. Average treatment effects and heterogeneity were assessed using G-computation modelling. Effect modifiers were identified using cluster modelling.
Results
The mHealth disease management programmes had an estimated risk difference in poor glycaemic control of −0.15 compared with conventional treatment. Through our clustering modelling, age ≤ 49 years, no dyslipidaemia diagnosis or prescription of related medication in the past 12 months, Charlson Comorbidity Index ≤ 3 and HbA1c ≥ 8.22% were identified to be associated with high benefit from the mHealth disease management programme.
Conclusions
mHealth-based disease management programmes may reduce the risk of poor glycaemic control. Young age, high baseline HbA1c levels and lower comorbidity burden were identified as the factors affecting efficacy. These results highlight the need for targeted interventions in mHealth disease management programmes.