Discussion
diabetes, hypoglycaemia
HYPOGLYCAEMIA, TYPE 1 DIABETES, DIABETES MELLITUS, TYPE 2 DIABETES, DIABETES
This RCT shows that POWER2DM integrated e-health support improved glycaemic control, QoL and self-management in people with diabetes mellitus, without increasing clinically relevant hypoglycaemia (blood glucose <3.0 mmol/l). POWER2DM integrated e-health support was well accepted in daily life by both those with type 1 diabetes and those with type 2 diabetes.Within the POWER2DM group, outcomes of blinded continuous glucose monitoring showed a decrease in time above range, together with a slight increase in time between 3.0 and 3.9 mmol/l, but no increase in clinically relevant hypoglycaemia (time below 3.0 mmol/l). As baseline glycaemic control was good in the POWER2DM group, with a mean HbAThe sub-analyses in our study indicated that the improvement in HbAPrevious studies on the effects of m-health and e-health interventions have reported similar findings of improved glycaemic control in people with type 1 diabetes [POWER2DM integrated e-health support distinguishes itself from other m-health and e-health systems by providing multifactorial support for both individuals with diabetes and healthcare professionals. However, the incorporation of multiple electronic interfaces, several connected devices and specific goal-oriented consultations with healthcare professionals makes it difficult to determine the effect of specific components of POWER2DM. Thus the effect of POWER2DM can only be evaluated as a whole, acknowledging that both an increase in consultation frequency [A limitation to this study is the fact that participants were not blinded to the intervention, so expectation bias cannot be ruled out. However, we observed the same effect size in objective outcomes such as HbAWhile implementation of the POWER2DM integrated e-health support system in standard care may initially require a financial investment in software and an investment of time spent teaching individuals how to use the system and interpret the results, we expect the system to be cost-effective in the long term. Studies have shown that educating people helps them understand the consequences of their self-management decisions and makes them feel empowered [User engagement with the POWER2DM integrated e-health support system gradually declined over time, as is commonly observed for m-health systems [In conclusion, the POWER2DM integrated e-health support system is unique in its design, aiming to bridge the gap in diabetes care between the diabetes clinic and daily life. Its multifaceted approach acknowledges the complexity of the various domains of self-management and how these domains intertwine. It automatically identifies potential barriers to self-management, and provides practical tools and psychoeducation to overcome these barriers. This study showed that the POWER2DM system is a safe and effective tool to support patients and healthcare professionals to improve glycaemic control and self-management. The POWER2DM integrated e-health support system provides a multifaceted intervention that could be easily implemented into daily clinical practice and help both patients and clinicians, with little training required.