Promoters of and Barriers to Engagement in Type 2 Diabetes Mellitus (T2DM) Populations with Real-World Technological Interventions

Glycemic control is often complicated by patients’ lack of adherence to treatment regimens and suboptimal self-efficacy behaviors. New technological interventions can help self-management, but it is often difficult to engage patients and maintain use. A systematic literature review of Medline, Embase, Cochrane CENTRAL, and manual searching identified literature reporting on technological interventions for T2DM to evaluate patient satisfaction affecting adherence. Observational studies and pragmatic clinical trials reporting intervention adherence and patient experience were evaluated for perceived promoters or barriers of intervention. The search retrieved 329 publications. Fourteen met criteria for inclusion and were analyzed. Adherence rates varied, ranging from 32-90% in web-based programs, to 28- 90% in telemedicine programs. Shorter follow-up times generally indicated better adherence. Patient-specific feedback was reported for 1,000 patients in 11 studies. Common patient-reported promoters of initiation and adherence included high level of provider interest, motivating, encouraging and personally relevant educational messaging. Barriers for the interventions included lack of motivational messaging, educational value, redundancy, technology-related limitations and overload concern. Technological interventions such as smartphone applications and patient web portals offer an opportunity to increase self-management in T2DM, further aided by strong healthcare provider promotion, support and engagement. In developing new technological interventions, it is important to consider easy-to-use individually-tailored content that is both motivational and educational. These programs will offer the best opportunities for adoption by providers and improved self-management by patients. Further review is needed to identify which technological interventions are most efficacious. Disclosure K.R. Duvall: Employee; Self; Sanofi. Stock/Shareholder; Self; Insulet Corporation, Sanofi, Becton, Dickinson and Company. A. Trasy: Employee; Self; Sanofi. Employee; Spouse/Partner; Bayer US. E. Murray: Consultant; Self; Sanofi. R. Milam: Employee; Self; Doctor Evidence. T. Sayre: None. A.C. Beal: Employee; Self; Sanofi. Board Member; Self; AcademyHealth.