Testing if a digital health enhanced model of type 2 diabetes care can be implemented in general practice settings for people with type 2 diabetes in Inala, Queensland, Australia.

The REMODeL ReIMCD project is a pilot implementation trial which adapts the successful REMODeL program originally designed for hospital outpatient settings. REMODeL is an eHealth-enhanced model of diabetes care that will be adapted for general practice settings through a previous study which co-designed the adaptations with general practitioners and people with diabetes receiving diabetes care in general practice settings. REMODeL integrates a commercially available digital diabetes management system called Health2Sync. The intervention enables patients to track their physical activity, nutrition, sleep and blood glucose using a wirelessly connected meter, receive personalised and contextually relevant self-management feedback and prompts via the Health2Sync app (participants will have the control to disable prompts if they wish), and share data seamlessly with clinicians, who can view results through a secure dashboard to support timely review, risk mitigation, and goal setting within routine care pathways. Examples of self-management feedback and prompts are as follows: “Hi {first_name}, thanks for downloading Health2Sync! We noticed you haven't entered any records yet. All you need to do is to tap the "+" button to begin! Try it out and you'll see how Health2Sync can help you!” – sent once only if participant has not entered or synchronised any measurements or entered data after installing. “You’re on the right track. Keep going!” – if participant has at least 2 readings within set target blood glucose range; sent once a week. “Hi {first_name}, great job sticking to your measurement plan! Keep up the good work!” – if participant follows their set self-measurement activities (e.g. blood glucose measurements) as per care plan set with clinician; at most once a week. Examples of self-management goals (examples only, these are set with clinicians as part of care planning): Blood glucose before meals: 4 – 7 mmol/L Blood glucose after meals: 5 – 10 mmol/L Regular blood glucose monitoring frequency: after waking up in the morning, 5min before any meals, 2 hrs after meals. For the 3-month study participation duration, participants of this trial will have access to and be asked to interact with Health2Sync based on their own preferences and diabetes self-management goals developed with the advice of clinicians at the trial site. Health2Sync can also facilitate clinician feedback via the app should there be updates to self-management needs or the clinician would like a check-in (e.g. the clinician has received any filtered pre-set clinical alerts). The research team will also assess and monitor app utilisation based on app use analytics. For clinicians, they have previously, in a separate study, codesigned how the use of Health2Sync fits into their current clinic workflow. An assigned clinician (e.g. credentialed diabetes educator) will be responsible for monitoring the Health2Sync clinician dashboard regularly (at least twice a week) for customised alerts and any participant communication (can be via the messaging function in the Health2Sync app, a phone call from the clinic or in-person at the clinic as required), however this clinician can informally do it more regularly as their work allows. Other clinicians, in this study they will be doctors (general practitioners and endocrinologists), at the clinic can access Health2Sync as needed and how often and when they access Health2Sync is one of our implementation trial outcome measures. At onboarding for participants with diabetes, clinicians will set self-management goals and other relevant care parameters into Health2Sync. Clinicians interact with participants virtually between any of their routine appointments or appointments where the participant is recalled to the clinic for any clinically relevant reason. All participants with diabetes joining the trial will undertake an approximately 3-week long ‘run-in’ period. The run-in period serves the purpose of (1) ensuring participants are given the opportunity to become familiar with the new technology; (2) enable participants time to ask questions and troubleshoot any problems with the technology; (3) ensure participants are willing to continue using the technology. If participants are unable to successfully complete the run-in period (i.e. comfortably use the technology), we will note, qualitatively, the factors that lead to run-in failure. This implementation aims to assess feasibility and generate practical insights for scaling an integrated, person-centred digital model of diabetes care across urban primary care settings.