Medication Optimization Among People With Type 2 Diabetes Participating in a Continuous Glucose Monitoring-Driven Virtual Care Program: Prospective Study

• Published in: JMIR formative research Vol. 6; no. 4; p. e31629
• Main Authors: Majithia, Amit R, Erani, David M, Kusiak, Coco M, Layne, Jennifer E, Lee, Amy Armento, Colangelo, Francis R, Romanelli, Robert J, Robertson, Scott, Brown, Shayla M, Dixon, Ronald F, Zisser, Howard
• Format: Journal Article
• Language: English
• Published: Canada JMIR Publications 05.04.2022
• Subjects: Antidiabetics; Blood pressure; Cholesterol; Diabetes; Endocrinology; Glucagon; Glucose; Glucose monitoring; Hemoglobin; Insulin; Laboratories; Lifestyles; Optimization; Original Paper; Sensors; Smartphones; Telemedicine; app; telemedicine; medication; monitoring; self-management; virtual care; lifestyle; digital health; type 2 diabetes; optimization; coaching; GLP-1 receptor agonist; continuous glucose monitoring; HbA1c; diabetes; prospective
• ISSN: 2561-326X; 2561-326X
• DOI: 10.2196/31629

The Onduo virtual care program for people with type 2 diabetes (T2D) includes a mobile app, remote lifestyle coaching, connected devices, and telemedicine consultations with endocrinologists for medication management and prescription of real-time continuous glucose monitoring (RT-CGM) devices. In a previously described 4-month prospective study of this program, adults with T2D and baseline glycated hemoglobin (HbA ) ≥8.0% to ≤12.0% experienced a mean HbA decrease of 1.6% with no significant increase in hypoglycemia. The objective of this analysis was to evaluate medication optimization and management in the 4-month prospective T2D study. Study participants received at least 1 telemedicine consultation with an Onduo endocrinologist for diabetes medication management and used RT-CGM intermittently to guide therapy and dosing. Medication changes were analyzed. Of 55 participants, 48 (87%) had a medication change consisting of a dose change, addition, or discontinuation. Of these, 15 (31%) participants had a net increase in number of diabetes medication classes from baseline. Mean time to first medication change for these participants was 36 days. The percentage of participants taking a glucagon-like peptide-1 receptor agonist increased from 25% (12/48) to 56% (n=27), while the percentages of participants taking a sulfonylurea or dipeptidyl peptidase 4 inhibitor decreased from 56% (n=27) to 33% (n=16) and 17% (n=8) to 6% (n=3), respectively. Prescriptions of other antidiabetic medication classes including insulin did not change significantly. The Onduo virtual care program can play an important role in providing timely access to guideline-based diabetes management medications and technologies for people with T2D. ClinicalTrials.gov NCT03865381; https://clinicaltrials.gov/ct2/show/NCT03865381.