Abstract
BACKGROUND: Digital health interventions, such as mobile diabetes apps, are aimed at supporting glycemic control. Real-world data (RWD) provide valuable insights into their long-term effectiveness beyond the controlled conditions of randomized trials. OBJECTIVE: This study evaluates the effectiveness of the mobile diabetes app ESYSTA in improving glycemic control using real-world evidence. METHODS: A retrospective analysis of 475 users was conducted to assess HbA1c changes after 6 months of usage and also long-term usage (12 and 15 months). A linear mixed model was used to adjust for confounding factors. RESULTS: After 6 months, ESYSTA users achieved a significant HbA1c reduction of -0.59 (-0.70; -0.48) percentage points compared to baseline, which was maintained for up to 15 months. Users with higher baseline HbA1c showed greater reductions. Seventy-five percent of users tracked their blood glucose values consistently during the whole observation period. CONCLUSION: These real-world evidence findings demonstrate the effectiveness of a mobile diabetes app in improving glycemic control over an extended period. While statistical adjustments addressed potential biases, missing data remain a challenge. Further research, including controlled studies, is needed to confirm these real-world results and further explore the underlying mechanisms of sustained HbA1c improvement.