Effectiveness of the Family Portal Function on the Lilly Connected Care Program (LCCP) for Patients With Type 2 Diabetes: Retrospective Cohort Study With Propensity Score Matching

Abstract

Background Diabetes is a major health concern worldwide. Family member engagement in diabetes self-management education programs can improve patients’ diabetes management. However, there is limited evidence that the family portal on diabetes management apps is effective in the glycemic control of patients with diabetes. Objective We aimed to evaluate the effectiveness of family support through the family portal function on Lilly Connected Care Program (LCCP) platform. Methods This retrospective cohort study included patients with type 2 diabetes recruited to the LCCP platform from September 1, 2018, to August 31, 2019. Propensity score matching was used to match family (group A) and non–family (group B) portal use groups with similar baseline characteristics. The patients were followed up with for 12 weeks. The main objectives were differences in mean fasting blood glucose, proportion of patients achieving fasting blood glucose target <7mmol/L, mean postprandial blood glucose, proportion of patients achieving postprandial blood glucose target <10mmol/L, proportion of patients achieving both fasting blood glucose <7mmol/L and postprandial blood glucose <10mmol/L, self-monitoring of blood glucose frequency at week 12 and the number of diabetes education courses patients completed during the 12 weeks. Moreover, logistic regression analysis was used to explore the baseline factors which may be associated with the use of family portal, and odds ratios with 95% confidence intervals were calculated. Results A total of 6582 adult patients (aged ≥18 years) with type 2 diabetes who were receiving insulin therapy were enrolled in the study. Overall, 6.1% (402/6582) of the patients chose to engage their family members to use the family portal. Two groups of 394 patients were well-matched regarding baseline characteristics. After matching, mean fasting blood glucose and postprandial blood glucose at week 12 were significantly lower in group A than in group B (fasting blood glucose: 7.12 mmol/L, SD 1.70 vs 7.42 mmol/L, SD 1.88, respectively, P=.02; postprandial blood glucose: 8.56 mmol/L, SD 2.51 vs 9.10 mmol/L, SD 2.69, respectively, P=.002). When comparing group A to group B, the proportion of patients achieving both fasting blood glucose <7mmol and postprandial blood glucose <10mmol/L at week 12 (46.8% vs 39.4%, respectively, P=.04), self-monitoring of blood glucose frequency at week 12 (8.92 times per week, SD 6.77 vs 8.02 times per week, SD 5.97, respectively, P=.05) and number of diabetes education courses completed in 12 weeks (23.00, IQR9.00-38.00 vs 15.00, IQR 4.00-36.00, respectively, P<.001) was higher. Additionally, multivariate logistic regression analysis showed that higher age (OR=0.987, 95% CI 0.978-0.996, P=.006) and higher baseline fasting blood glucose (OR=0.914, 95% CI 0.859-0.972, P=.004) were correlated with less use of the family portal function, while increased baseline self-monitoring of blood glucose frequency (OR=1.022, 95% CI 1.012-1.032], P<.001) as well as increased education courses (OR=1.026, 95% CI 1.015-1.036, P<.001) were associated with more use of the family portal function. Conclusions Family support through the LCCP family portal is effective for glycemic control and self-management behavior improvement in type 2 diabetes patients.

Effectiveness of the Lilly Connected Care Program in Improving Glycemic Management Among Patients With Type 2 Diabetes in China: Retrospective Real-world Study

“…Zhang et al [ 21 ] explored the effectiveness of the LCCP app-based diabetes education in glycemic control, where patients recruited to the LCCP were classified into 3 groups according to the number of courses taken (0-4 courses, 5-29 courses, and ≥30 courses) and the change in BG was compared between the groups, and showed that a larger number of diabetes education courses taken was associated with lower FBG and postprandial glucose control after 12-week follow-up. In another study, Zhang et al [ 20 ] evaluated the effectiveness of the family portal function in the LCCP in glycemic control and self-management behavior improvement. Patients with T2DM in the LCCP were categorized into the family portal group and non–family portal group based on whether the patients’ family members were engaged in using the family portal in their LCCP accounts.…”

“…In our study, we included patients not using the LCCP as the control group to provide further evidence of the effectiveness of the LCCP. Prior studies also illustrated the behavior improvement among LCCP users, such as the increased number of diabetes education courses taken and higher frequency of self-monitoring of BG [ 19 , 20 ]. We also used PSM to match the characteristics between 2 groups to control for potential confounders.…”

“…A total of 80,000 patients have registered in the LCCP. Patients can view their blood glucose (BG) readings in their WeChat accounts and receive customized diabetes education, individualized system-based reminders, family support through a family portal function, physician intervention, and call center support out of hospital [ 19 , 20 ]. The content of the prerecorded educational courses, which are evidence based and include diet and exercise advice, are reviewed by Lilly Medical and external experts and then unified and personalized for patients via the WeChat-based service account, or users can search for topics of interest on the platform to learn by themselves.…”

“…Thus, the LCCP is not only a device for BG monitoring but also an mHealth technology providing individualized and holistic self-management support to patients in China. Prior studies have demonstrated the effectiveness of the diabetes education within the LCCP in improving glycemic control in patients with T2DM using a single-arm design [ 20 , 21 ]; however, the comparative effectiveness of the overall LCCP versus not using the LCCP in glycemic control remains unknown.…”

U-shaped association between online information exchange and app usage frequency: a large-scale survey of China ‘s online young and middle-aged people with pre diabetes and diabetes

“…We observe that married people and cohabitation with their parents make up a significant portion of the high app usage frequency group, accounting for 73.1% and 83.3% respectively of the total. Evidence suggests this may have its origins in the advantages of family behavioral therapy, in which members of the family can actively communicate and take responsibility for one another in learning about and applying the latest developments in blood glucose management viathe use of apps (44,45). Brew-Sam et al, on the other hand, suggest that parental encouragement does not always lead to more app usage.…”