Effectiveness of mobile application (EASYDM) for diabetes control focusing on diabetes medication adherence among uncontrolled diabetes patients attending primary care units in Bangkok Thailand: a randomized controlled trial

Abstract

Introduction: Increasing uncontrolled diabetes mellitus requires ways to tackle it effectively. Primary Care Units (PCU) play an important role in diabetes care in Thailand. One option of diabetes management includes use of mobile applications that have proven effective. We investigated whether EASYDM mobile application is effective in diabetes control focusing on medication adherence among uncontrolled diabetes patients attending Primary Care Unit.

Method: A two-arm randomized assessor blinded controlled trial was conducted in between August to December 2019 at Pattanavej primary care unit in Saimai, Bangkok, Thailand. The sample was 186 patients who fulfill eligibility criteria of age 45-65 years, , type 2 diabetes with HbA1c > 7% assessed within previous 3 months and who are taking oral diabetic medications were randomized and assigned to intervention and control group in 1:1 ratio. Questionnaires were used to collect required data. Intervention group (n=93) was provided EASYDM with mobile application with functions and information designed and validated by experts to control diabetes while control group (n=93) received Usual Care provided by primary health care team. Primary outcome were self-reported medication adherence scores by Thai version Morisky Medication Adherence Scales-8 (TMMAS-8) and pill count medication percentage of monthly for 3 months. Secondary outcome was HbA1c level assessed at 3rd month in standard laboratory under National Health Security Office. Analysis was done by using Chi-square test, paired t-test, independent t-test, repeated measures ANOVA test and mixed between-within ANOVA test as appropriate.

The results: showed that self-reported Morisky Medication Adherence scores in EASYDM group increased across 3 time points measurement (1st month: 5.81±0.96 vs 5.40±1.12; p=0.008), (2nd month: 6.55±0.87 vs 5.39±1.08; p<0.001) and (3rd month: 7.47±0.76 vs 5.38±1.11; p<0.001) from (baseline: 4.61±0.57 vs 4.53±0.64; p=0.333) as compared to scores in Usual Care group. MMAS scores between EASYDM and Usual Care were significantly different [F (1,184) =147.502, p<0.001, ηp2 = 0.445]. Pill count medication adherence percentage was increased across 3 time points (1st month: 79.35±7.065 vs 72.98±5.560; p<0.001), (2nd month: 86.62±7.396 vs 72.96±6.243; p<0.001) and (3rd month: 96.37±5.938 vs 74.18±4.730; p<0.001) from (baseline: 72.72±7.420 vs 73.97±6.383; p=0221) as compared to scores in Usual care group. Pill count medication adherence percentage between EASYDM and Usual Care were significantly different [F (1,184) =296.334, p<0.001, ηp2 = 0.617]. HbA1c level at 3rd month was also reduced significantly in EASYDM group compared to level in Usual Care group (6.87±1.13 vs 9.55±1.69, p<0.001). In conclusion, EASYDM mobile application has impact on MMAS scores increase, improvement in pill count medication adherence percentage and reduced HbA1c level among uncontrolled diabetes patients in Thailand.

Conclusion and recommendation: EASYDM application has impacted on increasing in MMAS-8 scores and reducing HbA1c level among uncontrolled diabetes patients at PCU in Bangkok. However, Long term follow-up evaluation of this application for sustainability and an upgrade in line with emerging mobile technology to maintain acceptability and functionality would be required.