Real-World Evidence of a Hospital-Linked Digital Health App for the Control of Hypertension and Diabetes Mellitus in South Korea: Nationwide Multicenter Study

Background Digital health care apps have been widely used for managing chronic conditions such as diabetes mellitus and hypertension, providing promising prospects for enhanced health care delivery, increased patient engagement, and improved self-management. However, the impact of integrating these apps within hospital systems for managing such conditions still lacks conclusive evidence. Objective We aimed to investigate the real-world effectiveness of using hospital-linked digital health care apps in lowering blood pressure (BP) and blood glucose levels in patients with hypertension and diabetes mellitus. Methods Nationwide multicenter data on demographic characteristics and the use of a digital health care app from 233 hospitals were collected for participants aged 20 to 80 years in South Korea between August 2021 and June 2022. We divided the participants into 2 groups: 1 group consisted of individuals who exclusively used the digital health app (control) and the other group used the hospital-linked digital health app. All the patients participated in a 12-week digital health care intervention. We conducted a comparative analysis to assess the real-world effectiveness of the hospital-linked digital health app. The primary outcome was the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) level, and postprandial glucose (PPG) level between baseline and 12 weeks. Results A total of 1029 participants were analyzed for the FBG level, 527 participants were analyzed for the PPG level, and 2029 participants for the SBP and DBP were enrolled. After 12 weeks, a hospital-linked digital health app was found to reduce SBP (−5.4 mm Hg, 95% CI −7.0 to −3.9) and DBP (−2.4 mm Hg, 95% CI −3.4 to −1.4) in participants without hypertension and FBG level in all participants (those without diabetes, −4.4 mg/dL, 95% CI −7.9 to −1.0 and those with diabetes, −3.2 mg/dL, 95% CI −5.4 to −1.0); however, there was no statistically significant difference compared to the control group (using only digital health app). Specifically, participants with diabetes using a hospital-linked digital health app demonstrated a significant decrease in PPG after 12 weeks (−10.9 mg/dL, 95% CI −31.1 to −5.3) compared to those using only a digital health app (P=.006). Conclusions Hospital-linked digital interventions have greatly improved glucose control for diabetes compared with using digital health technology only. These hospital-linked digital health apps have the potential to offer consumers and health care professionals cost-effective support in decreasing glucose levels when used in conjunction with self-monitoring.

Rather than simply recording the numbers, we encourage patients to also record meaningful symptoms to help their doctor accurately assess the situation and determine whether medical intervention is necessary.This will help the doctor accurately assess why blood pressure is increasing.

[The process of using Well-check] Blood pressure_App
The blood pressure measurement guide can be reviewed at any time, and if you connect a Bluetooth blood pressure monitor, you can use it conveniently.When patients enter their blood pressure reading, they will receive automatic feedback by comparing their individualized blood pressure and blood sugar targets set by their doctor based on their hypertension and diabetes diagnosis.

Feedback on blood pressure (Medical intervention)
[The process of using Well-check] Blood pressure_App Based on patient's hypertension and diabetes diagnosis, the doctor sets individualized blood pressure and blood sugar targets for the patient, and patient will receive automatic feedback based on entered readings by comparing them to those targets.
If the entered blood pressure is too high or low compared to the target blood pressure, an alert will be sent to the doctor, and they can send feedback messages to manage it based on their judgment.
In the health record tab, patients can view blood pressure records and evaluate progress by comparing them to your personal blood pressure target, which is color-coded (high: red, low: purple, caution: orange, target: blue).
Blood pressure(Blood sugar, weight) records can be viewed in list form, tables, or graph form.
Explanation of the standard for the target blood pressure level.Well-check provides an easy-to-understand guide on how to measure blood sugar using a continuous blood sugar monitor to assist patients in measuring their blood sugar.
Detailed information on how to use a continuous blood sugar monitor can also be found in video format.

How to input blood sugar
Instead of just recording the numbers, Well-check encourages patients to record significant symptoms along with their blood sugar readings.This allows for a better understanding of why blood sugar levels may be high and whether medical intervention is truly necessary.It also helps the doctor make an accurate assessment of the patient's condition at the time.

View blood sugar records
In the health record tab, patients can view their blood sugar records and evaluate their progress by comparing them to their personal blood sugar target, which is color-coded (high: red, low: purple, caution: orange, target: blue).
Blood sugar (blood pressure, weight) records can be viewed in list form, tables, or graph form.
Explanation of the standard for the target blood sugar level.The table format is convenient for identifying cases where the blood sugar falls outside the target range.The graph format is useful for understanding the high and low trends of blood sugar.
In addition, it helps motivate patients by showing how well their blood sugar has been managed compared to the target over the past month.
[The process of using Well-check] Blood sugar_App

Add medication reminder / Check and record medication reminders
When turning off the alarm, patients can check whether they have taken their medication or not.Based on this, the doctor can also verify the patient's medication adherence.

Enter medication record
Patients can add medication records in the medication record tab.
When recording medication, a notification is automatically set up to help users with chronic diseases who need to continuously take medication remember and consistently take medication in the future.

Record a prescription (Upload a photo)
In the medication photo gallery tab, patients can also record medication using photos.
Patients can select the type of medication photo and easily enter a memo, and doctors can monitor the patient's medication history in detail.

Etc.
The process of using Well check_App -1.Message from the doctor -2.Health information -3.Health screening test instructions The messages sent to the patient by the doctor are displayed in the app as a chat UI.
[The process of using Well-check] Message from the doctor_App Patients can provide feedback on whether the doctor's messages were helpful through the button.Doctors can review this feedback and improve their messages accordingly.
1 2 1 2 [The process of using Well-check] Health information_App Well-check provides information helpful for managing chronic diseases, categorized and presented in a way that helps users easily learn the information they need.
Doctors can receive analysis results on an individual patient's blood pressure trend, average, and degree of deviation from the target over the past 1-3 months, allowing them to understand the patient's condition and use it in treatment.They can also check the trend of whether the blood pressure is being well managed through a graph.
Along with medication status, pre/postprandial blood glucose levels are displayed, so doctors can also check the extent of blood glucose levels according to medication.In addition, they can check the recent 1-3 month trend of blood glucose level and expected HbA1c level.
The doctor can receive an analysis of an individual patient's blood sugar trends, average, and how much they deviate from the target range over the past 1-3 months, and can use this information to assess the patient's condition and utilize it in treatment.They can also visually confirm the trend of blood sugar management through graphs.
Add medication reminder / Check and record medication reminders -2.Enter medication record -3.Record a prescription (Upload a photo) 1. Add medication reminder / Check and record medication reminders Patients can check whether they have taken their medication or not and add a medication reminder if needed.