For patients with type 2 diabetes, self-management remains a significant challenge. In recent years, the use of digital health technologies (DHTs) for chronic disease management has increased, with some facilitating improvements in diabetes outcomes. Historically, safety net systems have been slow to adopt DHTs, in part due to assumptions about literacy and the use of technology among low-income or non-English speaking patients. Additionally, the use of DHTs among diverse, low-income patient populations has not been well studied. NYC Health + Hospitals (H+H) is the largest safety net healthcare system in the nation. H+H launched a pilot program of BlueStar, an FDA-approved mobile app for diabetes self-management, among patients with poorly controlled type 2 diabetes at two of its acute care hospitals. The app was provided to patients in English and Spanish. Participants were able to record and receive feedback on their medications, blood glucose, blood pressure, and meals. Key aims of this pilot program were to: 1) increase patient education and support for diabetes self-management; 2) test the use of technology adaptation in a vulnerable patient population; and 3) improve diabetes outcomes as measured by reductions in A1c. Two hundred ninety-nine patients received the app, and 137 (46%) used the app at least once. Of these 137 patients, 52% used the app at least once per week; recording blood glucose and medication were the most frequently used features (82% and 62%, respectively). Among the first 196 patients enrolled, the mean reduction in A1c from baseline to six months post enrollment was 0.7 at hospital A (n=97) and 1.6 at hospital B (n=97). As compared to matched control patients at non-participating facilities, participants experienced a greater reduction in A1c of 0.1 (p=0.61) at hospital A and 0.7 (p=0.02) at hospital B. Results from the final analysis of all 299 participants as well as key themes from semi-structured interviews with patients will be presented.
R. Kalyanaraman Marcello: None. J. Dolle: None. S. Kaur: None. S.R. Patterson: None. N. Davis: None.
National Institutes of Health (UL1TR001445)