From the Journals

Putting diabetes tools ‘in the pocket’ improves HbA1c control


Patients with type 2 diabetes who were part of a health care plan and used a computer and/or app on a mobile device to access a portal (website) with tools for managing diabetes were more adherent with prescription refills and had improved hemoglobin A1c levels, according to findings from a 33-month study published online in JAMA Network Open.

The improvements were greater in patients without prior portal usage, who began accessing the portal via a mobile device (smartphone or tablet) app as well as computer, compared with those who used only a computer.

Moreover, the improvements were greatest in patients with poorly controlled diabetes (HbA1c greater than 8%) who began accessing the portal by both means.

Patients with greater clinical need were able to benefit even more from mobile portal access, both in taking their medications more often and in actually improving blood sugar levels,” lead author Ilana Graetz, PhD, an associate professor at the Rollins School of Health Policy and Management, Emory University, Atlanta, observed in a statement from Kaiser Permanente.

The results show that “patients can use technology to better manage their own care, their medications, and their diabetes,” added senior author Mary Reed, DrPH, a research scientist at the Kaiser Permanente Division of Research, Oakland, California. “This is an example of how the health care system, by offering patients access to their own information and the ability to manage their health care online, can improve their health.”

“Offering this in a mobile-friendly way can give even more patients the ability to engage with their health care,” Dr. Reed noted. “It literally puts the access to these tools in the patient’s own pocket wherever they go.”

Checking refills and lab results

Dr. Graetz and colleagues performed a retrospective analysis of data from 111,463 adults with type 2 diabetes who were not receiving insulin but were taking oral diabetes medications and were covered by a health care plan with Kaiser Permanente Northern California from April 1, 2015 to December 31, 2017. The patients were a mean age of 64 years, and 54% were men.

Patients could register online for free access to a portal that allowed them to get general health information and see their laboratory test results, as well as securely send and receive messages to and from their health care providers, make medical appointments, and request prescription refills.

Study outcomes were change in oral diabetes medication adherence and HbA1c levels at 33 months.

At baseline, 28% of patients had poor medication adherence (monthly days covered, less than 80%), and 20% had poor glycemic control.

After 33 months, the proportion of patients who never accessed the diabetes management portal dropped from 35% to 25%, and the proportion who accessed it from both a computer and an app increased from 34% to 62%.

Among patients with no prior portal access and who began accessing the portal by computer only, medication adherence increased by 1.16% and A1c dropped by 0.06%.

However, among patients with no prior portal access who began to access it using both a computer and an app, diabetes management improvement was greater: medication adherence increased by 1.67% and HbA1c levels dropped by 0.13%.

And among patients with no prior portal usage who had an initial HbA1c level of more than 8.0% and began to access the website by both means, medication adherence increased by 5.09%, equivalent to an added 1.5 medication-adherent days per month, and HbA1c levels fell by 0.19%.

There was also “a more modest, but still statistically significant increase,” of about 0.5 added medication-adherent days per month in patients with lower initial A1c levels who began accessing the portal both ways.

“Although medication adherence measured by medication dispensed cannot guarantee which medications were actually used by patients,” the authors wrote, “our findings of concurrent improvements in [HbA1c] levels confirm physiological improvements in diabetes control.”

“Convenient access to portal self-management tools through a mobile device could significantly improve diabetes management,” they conclude.

The study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. The authors reported no relevant financial relationships.

This article first appeared on

Next Article: