Digital tools for diabetes management
Health Technology Wales
Record ID 32018013713
English
Authors' objectives:
This report aims to identify and summarise evidence that addresses the following research question: What is the clinical and cost effectiveness of digital platforms for personalised diabetes management, education, and support in adults?
Authors' results and conclusions:
A total of 14 papers were identified in the literature search for this evidence appraisal report: eight randomised controlled trials; one economic evaluation; one European trial evaluation and four papers relating to patient, carer, and family considerations.
Improvements were found in several outcome measures because of digital platforms when compared to standard care. Outcomes include improvements in glycaemic control (i.e., HbA1c and fasting plasma glucose) which was the primary outcome, healthcare resource use, body weight, cholesterol levels, and patient reported outcome measures. HTW did not find any statistically significant outcomes relating to hypoglycaemic events and blood pressure. Key considerations include the comparability of the international evidence to settings used in Wales, differences in the types of digital platforms and their characteristics, and a lack of evidence to support a reduction in long-term complications. MyWay Diabetes, previously known as My Diabetes My Way (MDMW), is an example of such a platform.
An economic analysis identified in the literature review compared the use of MDMW and usual diabetes care in people with type 2 diabetes who do not require insulin. The analysis was based on observed reductions in HbA1c from a routine database of people with diabetes in NHS Scotland. The results of the analysis suggested that MDMW was more effective and less costly than usual diabetes care and therefore dominant. The conclusion of the analysis did not differ in the alternative scenarios considered in sensitivity analysis and MDMW was found to have a 100% probability of being cost effective in probabilistic sensitivity analysis. However, there were some potentially serious limitations identified in the analysis that should be considered when interpreting the findings.
A cost-utility analysis developed by HTW considered the cost effectiveness of digital platforms in the NHS Wales context. However, due to uncertainty around the availability and regulatory status of most digital platforms, the analysis focused on MyWay Diabetes only. HTW updated the published economic analysis for people with type 2 diabetes who do not require insulin. The HTW analysis found the platform to be more effective but more costly than usual care. The resulting incremental cost effectiveness ratio (ICER) of £4,577 per quality-adjusted life year (QALY) gained is lower than the cost effectiveness threshold of £20,000 per QALY, suggesting that the digital diabetes platform is cost effective. The result was insensitive to most changes considered in deterministic sensitivity analysis. In probabilistic sensitivity analysis, the digital platform was found to have a 97% probability of being cost effective at a threshold of £20,000 per QALY. However, the uncertainty in this conclusion will be underestimated.
HTW received a patient submission from Diabetes UK Cymru about the patient, carer, and family considerations of digital tools for the management of diabetes, including feedback on MyWay Diabetes. HTW also conducted a qualitative literature review of four studies which included in-depth questionnaires of active users and interviews of patients. Sub themes included several benefits of using MyWay Diabetes, complications in the use of MyWay Diabetes and patient suggestions for additional features.
Authors' recommendations:
This topic was brought forward at HTW Appraisal Panel on 30 April 2024. The Appraisal Panel concluded the evidence supports the routine adoption of the MyWay Diabetes digital platform for personalised management, education, and support for people with type 2 diabetes.
In people with type 2 diabetes who do not require insulin, the MyWay Diabetes digital platform is associated with improved glycaemic control compared to standard care.
Economic modelling suggests MyWay Diabetes is cost effective compared with standard care in people with type 2 diabetes who do not require insulin with an incremental cost-effectiveness ratio (ICER) of £4,577 per quality-adjusted life-year (QALY) gained.
The evidence does not support the use of other digital platforms for people with type 2 diabetes and HTW recommends further research on the use of other digital platforms for personalised management, education, and support in these patients.
The evidence does not support the routine adoption of digital platforms for personalised management, education, and support for people with type 1 diabetes. HTW recommends further research on the use of such platforms for people with type 1 diabetes.
Authors' methods:
The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.
Authors' identified further research:
HTW recommends further research on the use of digital platforms other than MyWay Diabetes for personalised management, education, and support for people with type 2 diabetes. HTW recommends further research on the use of digital platforms for personalised management, education, and support for people with type 1 diabetes.
Details
Project Status:
Completed
Year Published:
2024
URL for published report:
https://healthtechnology.wales/reports-guidance/mydiabetesmyway-2/
English language abstract:
An English language summary is available
Publication Type:
Rapid Review
Country:
Wales, United Kingdom
MeSH Terms
- Blood Glucose Self-Monitoring
- Diabetes Mellitus, Type 1
- Diabetes Mellitus, Type 2
- Patient Education as Topic
- Self-Management
- Patient Portals
- Telemedicine
- Digital Technology
- Mobile Applications
- Cost-Benefit Analysis
Keywords
- Type 1 Diabetes
- Type 2 Diabetes
- Diabetes app
- Glycaemic control
- Hypoglycaemia
Contact
Organisation Name:
Health Technology Wales
Contact Address:
c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD
Contact Name:
Susan Myles, PhD
Contact Email:
healthtechnology@wales.nhs.uk
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.