Integrated model of digital health and clinic care pathway: a prospective observational study to manage glycated haemoglobin levels and time in range among Indian subjects with type 2 diabetes mellitus

Abstract

Background: Good glycaemic control is difficult to achieve, especially with high glycated haemoglobin (HbA1c). The benefits of short-term dietary treatments and structured monitoring across severity levels are unknown. Severity-based category transitions may provide more clinically meaningful insight than mean HbA1c change alone.

Methods: To evaluate glycaemic change using a severity-stratified framework and to identify clinical and behavioral predictors of category improvement, with particular focus on baseline HbA1c, disease duration, and continuous glucose monitoring derived time-in-range. The analysis was performed on a cohort of 808 adults.

Results: To evaluate glycaemic change using a severity-stratified framework and to identify clinical and behavioral predictors of category improvement, with particular focus on baseline HbA1c, disease duration, and continuous glucose monitoring derived time-in-range. The analysis was performed on a cohort of 808 adults. At baseline, 23.4% were classified as controlled, 41.5% as uncontrolled, and 35.1% as severely uncontrolled. By 3–4 months, the proportion achieving glycaemic control had increased to 43.4%, corresponding to an absolute improvement of 20.0%. Overall mean HbA1c reduction was 1.34±1.79% (median 1.00%, IQR 0.20–2.15), with 68.0% achieving clinically meaningful improvement (≥0.5%; p<0.001).

Conclusions: Severity-stratified assessment provides clinically meaningful insight into real-world glycaemic outcomes. Structured monitoring combined with early metabolic feedback appears particularly effective in individuals with severe hyperglycaemia.