Abstract Body: Background: Cardiovascular disease (CVD) is the leading cause of death globally, and diabetes is a significant independent risk factor. Mobile health (mHealth) technology can enable effective self-management of CVD risk factors. This study evaluates the impact of an mHealth cardiovascular risk self-management program designed to promote behavioral and lifestyle changes on hemoglobin A1c (HbA1c) among participants with diabetes or prediabetes.
Methods: We analyzed real-world data from participants of the mHealth program between January 2020 and April 2024. Participants were included in the analysis if they had an A1c of >5.7% or a previous diagnosis of diabetes, as well as at least two A1c values available from linked electronic health records. Change in A1c was evaluated from baseline (measured up to 6 months before program enrollment) to follow-up. Participants were stratified according to their baseline A1c values (well-controlled: <7%; fairly-controlled: 7% to 9%; poorly-controlled: >9%) to separately evaluate the effects of program membership on A1c outcomes among individuals with different levels of diabetes severity.
Results: A total of 4,358 participants (mean age 56.2±11.2 years, 56.8% female, mean baseline A1c 6.8±1.4%) were included (Table 1). The mean follow-up period was 312.4 days. Pre- and post-enrollment A1c values are graphed in Figure 1. Participants with poorly-controlled baseline A1c (>9%, n=352) showed a significant reduction of 2.1% (from 10.1±1.4% to 8.0±1.9%; t(351) = -18.0, p < 0.001, d = -0.96). Those with fairly-controlled baseline A1c (7–9%, n=1,073) experienced a modest decrease of 0.2% (from 7.5±0.56% to 7.3±1.11%; t(1,072) = -7.2, p < 0.001, d = -0.22). Participants with well-controlled baseline A1c (<7%, n=2,933) remained well-controlled, with a clinically insignificant increase of 0.1% (from 6.0% to 6.1%; t(2,932) = 4.8, p < 0.001, d = 0.09).
Conclusion: Participants of an mHealth cardiovascular risk self-management program with poorly-controlled baseline A1c (>9%) decreased A1c significantly, while those with well-controlled baseline A1c (<7%) maintained A1c in this range. These findings highlight the potential of mHealth technology to support control of diabetes in the context of managing CVD risk.