Digital Diabetes Care System Observations from a Pilot Evaluation Study in Vietnam

Abstract

Digital technologies are gaining an important role in the management of patients with diabetes. We assessed clinical outcomes and user satisfaction of incorporating a digital diabetes care system in diabetes clinics of a developing country. The system integrated a wireless blood glucose monitor that communicates data to any smartphone utilizing a patented acoustic data transfer method, a mobile-app, and cloud-based software that stores, analyzes, and presents data. Five hospital endocrinology clinics in Vietnam sequentially recruited all patients willing to join the study, providing they had a smartphone and access to internet connectivity. Face-to-face visits were conducted at baseline and at 12 weeks, with monthly digital visits scheduled in the interim and additional digital visits performed as needed. HbA1c levels were measured at baseline and at 12 weeks (±20 days). The study included 300 patients of whom 279 completed the evaluation. Average glucose levels declined from 170.4 ± 64.6 mg/dL in the first 2 weeks to 150.8 ± 53.2 mg/dL in the last 2 weeks (n = 221; p < 0.001). HbA1c levels at baseline and 12 weeks declined from 8.3% ± 1.9% to 7.6% ± 1.3% (n = 126; p < 0.001). The digital solution was broadly accepted by both patients and healthcare professionals and improved glycemic outcomes. The durability, scalability, and cost-effectiveness of this approach merits further study.

Mobile Health Interventions to Improve Health Behaviors and Healthcare Services among Vietnamese Individuals: A Systematic Review

“…These investigators attributed their high engagement and retention rates to the intensive reminders sent by their support staff using SMS, online chat group, and hotline telephone services. Although there was a gradual decline in patient engagement over the 12-week intervention period, glucose and HbA1c levels were significantly lower after the intervention [18]. The investigators attributed this finding to potential learning, information retention, lifestyle adjustment, and medication regimen adherence by the subjects.…”

“…Six studies intended to improve health behavior changes, including treatment adherence [13,14], mental health care [15], and smoking cessation [11,12,16]. Eight studies intended to improve healthcare services, including medical records management [17], health monitoring and support [9,18,19], vaccination management [10], patient-provider communication [8], and follow-up care [20,21].…”

“…The majority (9/14; 64%) of studies included were designed to evaluate feasibility with outcome measures on recruitment, engagement, and retention. Six studies reported recruitment rates ranging from 51% to 99% [12][13][14][15][16]18]. These investigators attributed their high rates of recruitment and engagement to the modification and cultural adaptation of the mHealth interventions using participants' suggestions as well as administrative support of project activities from top leaders.…”

“…They found that most participants liked the SMS and described it as helpful and useful. Khanh et al [18] reported patient and provider satisfaction with the digital diabetes care system, and Nguyen et al [13] reported patient satisfaction with the video directly observed therapy to support pulmonary tuberculosis treatment adherence post-intervention. Others reported high satisfaction with frequency and timing of SMS messages (two to four per day at participants' preferred time) and that participants were willing to pay a fee for this service [8,10,14,17].…”

Efficacy of a Mobile Phone–Based Intervention on Health Behaviors and HIV/AIDS Treatment Management: Randomized Controlled Trial

“…In Vietnam, it is estimated that 250,000 individuals, including both adults and children, are living with HIV, 169,000 of whom are receiving ART [15]. Although mHealth apps are effective tools to complement existing care, to date, no study in Vietnam has attempted to investigate the potential of mobile-based interventions for individuals living with HIV [16]. Therefore, the aim of this study was to evaluate the feasibility and efficacy of a theory-based mHealth intervention on HIV treatment adherence, self-efficacy, and health behaviors among people living with HIV in Vietnam.…”