title: Mobile Diabetes Intervention for Glycemic Control: Impact on Physician Prescribing.
abstract: Of adults with type 2 diabetes, 84% take antihyperglycemic medication. Successful treatment requires active monitoring and medication dose adjustment by health providers. The objective of this study was to determine how a mobile-phone-based coaching system for diabetes management influences physician prescribing behavior. This secondary data analysis is based on a cluster randomized clinical trial that reported patients provided with mobile self-management had reduction in glycated hemoglobin (HbA1c) of 1.9% over 1 year, compared to 0.7% in control patients (P < .001). Participants were primary care patients with type 2 diabetes randomized at physician practice level into a control group (n = 55) and intervention group (n = 62). Main study measures were patients' medication records (medication, dose, frequency, start and end date) abstracted at baseline and study end. Antihyperglycemic medications, including sulfonylureas or thiazolidinediones, and antihypertensive and antilipemic medications were analyzed. A higher percentage of patients in the intervention group had modification and intensification of incretin mimetics during the 1-year study period (9.7% vs 0.0% and 8.1% vs 0.0%, both P = .008). A higher percentage of patients in the intervention group had modification and intensification of metformin (24.2% vs 7.3%, P = .033). The overall difference in physician prescribing of oral antihyperglycemic medications was not statistically significant. Our results suggest mobile diabetes interventions can encourage physicians to modify and intensify antihyperglycemic medications in patients with type 2 diabetes. Differences in physician prescribing behavior were modest, and do not appear to be large enough to explain a 1.2% decrease in HbA1c.
authors.affiliation: Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA cquinn@epi.umaryland.edu.
authors.forename: Charlene C
authors.initials: CC
authors.lastname: Quinn
authors.affiliation: Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Sareh
authors.affiliation: Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Shardell
authors.affiliation: Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Terrin
authors.affiliation: Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Erik A
authors.initials: EA
authors.lastname: Barr
authors.affiliation: Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Ann L
authors.initials: AL
authors.lastname: Gruber-Baldini
keywords: adherence; diabetes; mobile health; physician; prescription