Eric Andrew Finkelstein, Daphne Su-Lyn Gardner, Kwang Wei Tham, Mihir Gandhi, Yin Bun Cheung, Joann Bairavi, Chun Fan Lee, Ngiap Chuan Tan, Ester Yeoh, Phong Ching Lee, Emily Tse Lin Ho, Thofique Adamjee, Yong Mong Bee, Su-Yen Goh
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引用次数: 0
Abstract
Aim: Digital health interventions and economic incentives have shown promise in facilitating diabetes self-management, though evidence is limited. Therefore, this study aimed to evaluate the effectiveness and cost-effectiveness of a comprehensive app-based diabetes self-management programme with rewards for healthy behaviours and health outcomes.
Materials and methods: The TRIal to slow the Progression Of Diabetes (TRIPOD) study was an open-label, parallel-group, randomised controlled trial conducted at Duke-NUS Medical School, Singapore. Adults with Type 2 Diabetes (diabetes), HbA1c of 7.5%-11.0% (inclusive) and taking at least one oral diabetes medication were eligible. In total, 269 participants were randomised across three arms [Usual care (UC): 117, diabetes management programme (DMP) (intervention without rewards): 36, DMP+ (intervention with rewards): 116]. Data were analysed using intention-to-treat analysis with change in HbA1c at month 12 between DMP+ and UC as the primary outcome. Cost-effectiveness of DMP+ relative to UC was also calculated.
Results: Mean HbA1c improved by 0.1% in UC and by 0.5% in DMP+ at 12 months, revealing a mean difference of 0.4% (95% confidence interval (CI): -0.70, -0.08, p = 0.015). The odds ratio of HbA1c improvements of >0.5% was 2.12 (95% CI: 1.17, 3.85, p = 0.013) for DMP+ relative to UC. The incremental cost-effectiveness ratio of DMP+ relative to UC was SGD8,516 (USD6,531) per quality-adjusted life year gained if effectiveness could be maintained with a single year of intervention.
Conclusions: A comprehensive app-based diabetes self-management programme with rewards for healthy behaviours and health outcomes (DMP+) cost-effectively improved glycaemic control in Type 2 diabetes patients. Organizations focusing on value-based healthcare should consider subsidising similar interventions.
期刊介绍：
Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.
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