@Article{info:doi/10.2196/35790,
author="Makan, Hemant
and Makan, Lindie
and Lubbe, Jacqueline
and Alami, Sarah
and Lancman, Guila
and Schaller, Manuella
and Delval, C{\'e}cile
and Kok, Adri",
title="Clinical and Economic Assessment of MyDiaCare, Digital Tools Combined With Diabetes Nurse Educator Support, for Managing Diabetes in South Africa: Observational Multicenter, Retrospective Study Associated With a Budget Impact Model",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="7",
volume="7",
pages="e35790",
keywords="diabetes mellitus; diabetes nurse educator; digital tool; MyDiaCare program; type 2",
abstract="Background: In South Africa, diabetes prevalence is expected to reach 5.4 million by 2030. In South Africa, diabetes-related complications severely impact not only patient health and quality of life but also the economy. Objective: The Diabetes Nurse Educator (DNE) study assessed the benefit of adding the MyDiaCare program to standard of care for managing patients with type 1 and type 2 diabetes in South Africa. An economic study was also performed to estimate the budget impact of adding MyDiaCare to standard of care for patients with type 2 diabetes older than 19 years treated in the South African private health care sector. Methods: The real-world DNE study was designed as an observational, retrospective, multicenter, single-group study. Eligible patients were older than 18 years and had at least 6 months of participation in the MyDiaCare program. The MyDiaCare program combines a patient mobile app and a health care professional platform with face-to-face visits with a DNE. The benefit of MyDiaCare was assessed by the changes in glycated hemoglobin (HbA1c) levels, the proportion of patients achieving clinical and biological targets, adherence to care plans, and satisfaction after 6 months of participating in the MyDiaCare program. A budget impact model was performed using data from the DNE study and another South African cohort of the DISCOVERY study to estimate the economic impact of MyDiaCare. Results: Between November 25, 2019, and June 30, 2020, a total of 117 patients (8 with type 1 diabetes and 109 with type 2 diabetes) were enrolled in 2 centers. After 6 months of MyDiaCare, a clinically relevant decrease in mean HbA1c levels of 0.6{\%} from 7.8{\%} to 7.2{\%} was observed. Furthermore, 54{\%} (43/79) of patients reached or maintained their HbA1c targets at 6 months. Most patients achieved their targets for blood pressure (53/79, 67{\%} for systolic and 70/79, 89{\%} for diastolic blood pressure) and lipid parameters (49/71, 69{\%} for low-density-lipoprotein [LDL] cholesterol, 41/71, 58{\%} for high-density-lipoprotein [HDL] cholesterol, and 59/71, 83{\%} for total cholesterol), but fewer patients achieved their targets for triglycerides (32/70, 46{\%}), waist circumference (12/68, 18{\%}), and body weight (13/76, 17{\%}). The mean overall adherence to the MyDiaCare care plan was 93{\%}. Most patients (87/117, 74{\%}) were satisfied with the MyDiaCare program. The net budget impact per patient with type 2 diabetes, older than 19 years, treated in the private sector using MyDiaCare was estimated to be approximately South African Rands (ZAR) 71,023 (US {\$}4089) during the first year of introducing MyDiaCare. Conclusions: The results of using MyDiaCare program, which combines digital tools for patients and health care professionals with DNE support, suggest that it may be a clinically effective and cost-saving solution for diabetes management in the South African private health care sector. ",
issn="2561-326X",
doi="10.2196/35790",
url="https://formative.jmir.org/2023/1/e35790",
url="https://doi.org/10.2196/35790",
url="http://www.ncbi.nlm.nih.gov/pubmed/37548994"
}