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Mobile apps support self-management, may prevent future ‘diabetes dropout’
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Patients with diabetes who have dropped out of diabetic care may be suitable candidates for mobile technologies that support self-management, which may prevent future dropout, according to findings from a cross-sectional study.
“Dropout rates of diabetes patients are undesirably high, and preventing dropout is crucial because it is likely to result in poor glycemic control and [a] higher risk of complications,” Satoko Yamaguchi, of the department of Ubiquitous Health Informatics at the University of Tokyo Graduate School of Medicine, and colleagues wrote. Recent studies have shown that [mobile health] technologies are effective in improving glycemic control and medication adherence in diabetes patients ... however, it has not been determined whether patients who have previously dropped out could be suitable candidates for [mobile health] since patients’ willingness to engage in [mobile health] would be crucial.”
Yamaguchi and colleagues analyzed data from 307 patients with both type 1 (n = 16) and type 2 diabetes (n = 291) who regularly visited the outpatient unit at the University of Tokyo Hospital between August 2014 and March 2015 (mean age, 66 years; mean duration of diabetes, 15.4 years; 52 with previous mobile health experience). Researchers collected data through in-person interviews and medical records; patients were shown a mobile health app called DialBetics as an example, and asked about their willingness to use such an application. Patients were asked if they had ever discontinued their diabetes care; dropout was defined as intentional interruption of regular visits to the doctor (occasional medication nonadherence was not considered as dropout).
Within the cohort, 34 patients (11.1%) had previously dropped out from diabetic care. Researchers found that previous use of a mobile health app was a negative predictor of dropout (OR = 0.211; 95% CI, 0.055-0.81). In addition, patients who had previously dropped out of diabetic care were more likely to express willingness to use a mobile app vs. those who had not previously dropped out of care (79.4% vs. 54.4%; P = .002). Results persisted after adjustment for diabetes duration, family history, alcohol consumption and physical activity (OR = 3.87; 95% CI, 1.540-9.76). “A multivariate analysis found that a history of dropout was a strong predictor of willingness to use mobile health,” Kayo Waki, MD, MPH, PhD, associate professor in the department of ubiquitous health informatics at the University of Tokyo Graduate School of Medicine, told Endocrine Today. “It was not the background factors affecting dropout, but dropout itself that was associated with willingness.”
Patients who had previously dropped out of care cited lack of perceived necessity (35.3%), being too busy with work (26.5%), relocation (11.8%), other diseases (5.9%) and a poor relationship with the physician (5.9%) as reasons for discontinuing care.
“Physicians and diabetes care provider should consider mobile health as one of the options of diabetes care for patients with diabetes who are at high risk of dropping out of care,” Waki said. “Further study is needed for measuring clinical effects — especially to evaluate whether long-term compliance and glucose control is improved by mobile health among the targeted population of patients who dropped out.” –by Regina Schaffer
For more information:
Kayo Waki, MD, MPH, PhD, can be reached at the University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan; email: kwaki-tky@umin.ac.jp.
Disclosure: This study was funded by NTT DOCOMO.
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