Smartphone app intervention helps tackle medication nonadherence in Asian T2D patients

A smartphone app intervention for type 2 diabetes (T2D) patients with poor medication adherence helps increase adherence awareness and reduce barriers to taking the medications as prescribed, according to the results of a feasibility study from Singapore.

“This study allowed us to better understand the impact of a health app on patients with T2D and identify potential problems that could occur before scaling up,” said lead researcher Zhilian Huang from the Nanyang Technological University.

Huang and colleagues randomly assigned 51 digitally literate T2D patients with poor medication adherence to the intervention (n=25) or control (n=26) group. All participants received usual care, while those in the intervention group were asked to download and use an app to help them manage their medications for 12 weeks.

For the app, the researchers selected Medisafe, a free, commercial app with evidence supporting its effectiveness. The app features medication scheduling, reminder, tracking, data sharing and medication adherence assessments. [https://www.iqvia.com/institute/reports/the-growing-value-of-digital-health; JMIR Mhealth Uhealth 2016;4:e132]

Of the participants, 22 (88.0 percent) and 19 (73.1 percent) in the intervention and control group, respectively, completed the postintervention survey. The average individual 12-week medication adherence rate tracked by the app was between 38.3 percent and 100 percent, with eight participants having 100 percent adherence for the first 2 weeks of the intervention. [JMIR Mhealth Uhealth 2019;7:e14914]

“Despite differences in app usage patterns between participants, the aggregated weekly medication adherence tracked by the app did not fall below 50 percent over the 12 weeks,” Huang noted.

Majority of the users (>80 percent) agreed that the app was easy to use and made them more adherent to their medication. They also responded positively when asked if they would recommend the app to another T2D patient.

At the end of the intervention, self-reported barriers to medication decreased with the use of the app but increased with usual care only (mean between-group difference in ASK-12 scores, 4.7; p=0.01). This outcome was measured using the Adherence Starts with Knowledge-12, with higher scores indicating higher barriers.

However, the reduction in medication barriers did not translate to improvements in clinical outcomes. Specifically, there were no significant between-group differences observed in the Appraisal of Diabetes Scale score, HbA_1c, lipids and body mass index.

The present data established the feasibility and acceptability of a smartphone app intervention for improving medication adherence in T2D, despite the presence of several limitations to the study. Factors that influenced feasibility include digital literacy, health-seeking behaviour, app usability and the time period of the intervention.

Huang and colleagues consequently proposed that a full randomized controlled trial be conducted, with a fivefold scale-up to reach full trial power under the same conditions. “This can be achieved with the involvement of more physicians, more study sites, or a longer recruitment period. Future studies should assess factors that could enhance the usability of apps in older adults who are less technologically savvy.

“The app usage behaviour of different patient subgroups and interaction between various diabetes app features can also be explored,” they added.