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

Amit R Majithia; David M Erani; Coco M Kusiak; Jennifer E Layne; Amy Armento Lee; Francis R Colangelo; Robert J Romanelli; Scott Robertson; Shayla M Brown; Ronald F Dixon; Howard Zisser

doi:10.2196/31629

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

JMIR Form Res. 2022 Apr 5;6(4):e31629. doi: 10.2196/31629.

Authors

Affiliations

¹ Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, United States.
² Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, CA, United States.
³ Onduo Professionals PC, Newton, MA, United States.
⁴ Verily Life Sciences, South San Francisco, CA, United States.
⁵ Onduo LLC, Newton, MA, United States.
⁶ Allegheny Health Network, Monroeville, PA, United States.
⁷ Sutter Health, Palo Alto, CA, United States.

PMID: 35147501
PMCID: PMC9019640
DOI: 10.2196/31629

Abstract

Background: 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_1c) ≥8.0% to ≤12.0% experienced a mean HbA_1c decrease of 1.6% with no significant increase in hypoglycemia.

Objective: The objective of this analysis was to evaluate medication optimization and management in the 4-month prospective T2D study.

Methods: 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.

Results: 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.

Conclusions: 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.

Trial registration: ClinicalTrials.gov NCT03865381; https://clinicaltrials.gov/ct2/show/NCT03865381.

Keywords: GLP-1 receptor agonist; HbA1c; app; coaching; continuous glucose monitoring; diabetes; digital health; lifestyle; medication; monitoring; optimization; prospective; self-management; telemedicine; type 2 diabetes; virtual care.

©Amit R Majithia, David M Erani, Coco M Kusiak, Jennifer E Layne, Amy Armento Lee, Francis R Colangelo, Robert J Romanelli, Scott Robertson, Shayla M Brown, Ronald F Dixon, Howard Zisser. Originally published in JMIR Formative Research (https://formative.jmir.org), 05.04.2022.

Associated data

ClinicalTrials.gov/NCT03865381