Real-world Benefits of Diabetes Management App Use and Self-monitoring of Blood Glucose on Glycemic Control: Retrospective Analyses.

BACKGROUND: Among self-care measures, the self-monitoring of blood glucose (SMBG) is a critical component for checking blood glucose levels. In addition, there is growing evidence suggesting that digital technologies are being adopted as an additional method for health care systems to increase patient contact. However, for patients with non-insulin-treated diabetes mellitus type 2 (DMT2), the value of SMBG was inconsistent among studies, and the evidence for digital technologies from real-world clinical practice is still limited. OBJECTIVE: Our study aimed to assess patients with non-insulin-treated DMT2 who were receiving care from a single clinic and analyze whether the use of a diabetes management app and SMBG behavior would affect glycemic control in a real-world clinical setting. METHODS: We collaborated with a large clinic focused on diabetes care in Taiwan that had been using the Health2Sync mobile app and web-based Patient Management Platform to collect the data. The patients were divided into 2 groups (app-engaged-user group and only-data-uploader group) according to different activities in the app, and blood glucose was recorded every month from 1 to 6 months after registration in the app. A sample of 420 patients was included in the analysis, and a linear mixed model was built to investigate which factors affected the patients' blood glucose percentage change. RESULTS: Using the mixed model coefficient estimates, we found that the percentage change was significantly negative when the only-data-uploader group was set as the baseline (t=-3.873, df=1.81 × 104; P<.001 for the patients of the app-engaged-user group). We found that for patients with shorter diabetes duration, their blood glucose decreased more than patients with longer diabetes duration (t=2.823, df=1.71 × 104; P=.005 for the number of years of diabetes duration). In addition, we found that for younger patients, their blood glucose decreased more than older patients (t=2.652, df=1.71 × 104; P=.008 for the age of the patients). Furthermore, the patients with an education level of junior high school or lower saw a significantly greater decrease in blood glucose percentage change than the patients with an education level of senior high school or higher (t=4.996, df=1.72 × 104; P<.001 for the patients with an education level of senior high school or higher). We also found that the count of blood glucose measured enlarged the decrease along the interaction months (t=-8.266, df=1.97 × 104; P<.001 for the nth month × the count of blood glucose in the nth month). Lastly, the gender of the patients did not significantly affect the percentage change (t=0.534, df=1.74 × 104; P=.59 for female patients). CONCLUSIONS: Our analysis showed the following: the blood glucose percentage change of the patients in the app-engaged-user group dropped more than that in the only-data-uploader group; shorter diabetes duration is associated with a steeper decrease in the patients' blood glucose percentage change; the percentage decrease in blood glucose change in younger patients is greater than older patients; the blood glucose percentage change of the patients with an education level of junior high school or lower dropped more than those with an education level of senior high school or higher; and the more frequently the patients test SMBG each month, the greater the decrease in the patients' blood glucose percentage. Further studies can be performed to consider the differences in daily behaviors such as exercise and diet across the patients and whether these factors could have vital effects on glycemic control.

The Effects of Continuous Usage of a Diabetes Management App on Glycemic Control in Real-world Clinical Practice: Retrospective Analysis.

BACKGROUND: The efficacy of digital technology in improving diabetes management has typically been demonstrated through studies such as randomized controlled trials, which have reported a steeper reduction in hemoglobin A1c (HbA1c) values for patients who adopted a digital solution. However, evidence from real-world clinical practice is still limited. OBJECTIVE: This study aimed to evaluate the effectiveness of digital interventions by tracking HbA1c improvements over 1 year in real-world clinical settings. METHODS: Patients used the Health2Sync mobile app to track self-measured outcomes and communicate with health care professionals (HCPs). HCPs used the web-based Patient Management Platform to monitor patient data, view test results from clinical laboratories, and communicate with patients. Patients who have been onboarded for at least 13 months and have consecutive HbA1c findings for 5 quarters were included in the analysis. They were then stratified into 3 groups (high, mid, and low retention) based on their level of use of Health2Sync in the first 6 months of onboarding. A mixed model was built to compare the slopes of the rate of reduction in HbA1c among the groups. In addition, these patients' retention on the app from the seventh to the 12th month was verified through multiple comparisons. RESULTS: A sample of 2036 users was included in the analysis. With the mixed model coefficient estimates, we found that app users had significant HbA1c percentage reductions as the passed quarter count increased (t=-9.869; P<.001), and that effectiveness increased in the high (t=-5.173) and mid retention (t=-6.620) groups as the interaction effects were significantly negative compared to that in the low retention group (P<.001) in the passed quarter count. The low retention group also had the highest average HbA1c value at the end of 13 months (high: 7.01%, SD 1.02%; mid: 6.99%, SD 1.00%; low: 7.17%, SD 1.14%) (Bonferroni correction: high vs low, P=.07; mid vs low, P=.02; high vs mid, P>.99). The level of use of the app remained consistent in the seventh to the 12th month after onboarding (high: 5.23 [SD 1.37] months, mid: 2.43 [SD 1.68] months, low: 0.41 [SD 0.97] months) (P<.001). CONCLUSIONS: Our analysis shows that continuous usage of the diabetes management app is associated with better glycemic control in real-world clinical practice. Further studies are required to reveal the efficacy for specific diabetes types and to observe effects beyond 1 year.

Default-mode network activation underlies accurate contextual processing of exclusive disjunctions in older but not younger adults.

Young adults proactively engage frontoparietal processing of contextual cues to preempt subsequent events. Rather than being preemptive, older adults engage these brain areas reactively upon event occurrences. Reactive frontoparietal processes in older adults, however, might be insufficient for complex contextual neural computations where utilities of contexts are not straightforward but dependent on a set of stimulus-response rules. Applying non-linear logic (XOR) rules in an fMRI experiment, we found higher default-mode network (DMN) activity critical for correctly responding to such contingency in older but not younger adults. Moreover, older individuals with higher proactive cue processing showed better performances with less DMN activity. Thus, DMN processing provides critical support when older adults are faced with complex contextual contingencies. These findings suggest an age-related change in the neurocomputational role of introspective processes in decision-making from young to older adulthood.

East Asian Young and Older Adult Perceptions of Emotional Faces From an Age- and Sex-Fair East Asian Facial Expression Database.

There is increasing interest in clarifying how different face emotion expressions are perceived by people from different cultures, of different ages and sex. However, scant availability of well-controlled emotional face stimuli from non-Western populations limit the evaluation of cultural differences in face emotion perception and how this might be modulated by age and sex differences. We present a database of East Asian face expression stimuli, enacted by young and older, male and female, Taiwanese using the Facial Action Coding System (FACS). Combined with a prior database, this present database consists of 90 identities with happy, sad, angry, fearful, disgusted, surprised and neutral expressions amounting to 628 photographs. Twenty young and 24 older East Asian raters scored the photographs for intensities of multiple-dimensions of emotions and induced affect. Multivariate analyses characterized the dimensionality of perceived emotions and quantified effects of age and sex. We also applied commercial software to extract computer-based metrics of emotions in photographs. Taiwanese raters perceived happy faces as one category, sad, angry, and disgusted expressions as one category, and fearful and surprised expressions as one category. Younger females were more sensitive to face emotions than younger males. Whereas, older males showed reduced face emotion sensitivity, older female sensitivity was similar or accentuated relative to young females. Commercial software dissociated six emotions according to the FACS demonstrating that defining visual features were present. Our findings show that East Asians perceive a different dimensionality of emotions than Western-based definitions in face recognition software, regardless of age and sex. Critically, stimuli with detailed cultural norms are indispensable in interpreting neural and behavioral responses involving human facial expression processing. To this end, we add to the tools, which are available upon request, for conducting such research.