ArticleJMIR formative research2026
Remote Glucose Monitoring Engagement and Glycemic Control in Type 2 Diabetes and Prediabetes: Retrospective Cohort Study.
Article in JMIR formative research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSuboptimal glycemic control remains a significant public health challenge among adults with type 2 diabetes and prediabetes, with 47.4% of US adults with diagnosed diabetes having HbA1c ≥7.0%. Remote glucose monitoring programs have shown promise for supporting self-management, but real-world evidence on the causal impact of varying patient engagement levels on glycemic outcomes remains limited.
objectiveTo estimate the causal dose-response relationship between patient engagement, operationalized as weekly glucose monitoring frequency, and glycemic control measured by hemoglobin A1c (HbA1c), among adults enrolled in a comprehensive primary care-integrated remote monitoring program.
methodsWe conducted a retrospective cohort study of 1,436 adults with type 2 diabetes or prediabetes enrolled in the iHealth Unified Care program between 2019 and 2024. The program integrated Bluetooth-connected glucose meters, a mobile application, structured lifestyle coaching, and primary care coordination across 74 physician practices. Engagement was defined as mean weekly glucose monitoring frequency during the first 6 months. The causal effect of monitoring frequency on 6-month HbA1c was estimated using marginal structural models (MSMs) with inverse probability weighting (IPW) to address time-varying confounding. Covariates included age, sex, BMI, baseline HbA1c, comorbidities, medication status, and physical activity level.
resultsThe cohort was predominantly older (95.4% aged ≥46 years), with 82.6% having hypertension and 45.9% classified as obese. Overall, HbA1c decreased by 0.54 percentage points (95% CI 0.47-0.62; P < .001) over 6 months. Cluster analysis identified three engagement tiers: low (n=835; mean 2.55 measurements/week), medium (n=493; 6.19/week), and high (n=108; 12.59/week). A monotonic dose-response was observed, with HbA1c reductions of 0.38 (95% CI 0.29-0.48), 0.71 (95% CI 0.58-0.85), and 1.01 (95% CI 0.69-1.32) percentage points for the low, medium, and high tiers, respectively (all P < .001 by paired t-test). In weighted MSMs, each additional weekly measurement was associated with a 0.05 percentage point greater HbA1c reduction (95% CI 0.03-0.07; P < .001). Among patients with high baseline HbA1c (≥9.0%), the high-engagement group achieved a mean reduction of 3.12 percentage points (95% CI 2.29-3.94). Findings were consistent in sensitivity analyses at 3 months (β = -0.04; P < .01) and 12 months (β = -0.03; P < .01) and across alternative weighting specifications.
conclusionsHigher engagement with a digitally enabled, primary care-integrated remote glucose monitoring program was causally associated with significantly greater HbA1c reductions in adults with type 2 diabetes and prediabetes. These findings support scalable remote patient monitoring strategies that actively foster sustained patient engagement as an effective approach to improving glycemic control and reducing the burden of diabetes-related complications at a population level. CLINICALTRIAL:
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