Country-Specific Differences in Glycemic Outcomes Using Real-World Data from the mySugr® App for Diabetes Self-Management

Introduction: Digital diabetes technologies have the potential to enhance disease self-management and reduce the socioeconomic burden on health care systems. This retrospective real-world data study aimed to investigate the impact of the mySugr® app on glycemic outcomes on a global scale and within individual countries to identify socioeconomic factors that influence country-specific outcomes. Methods: From January 2018 to October 2024, data were collected from 13,826 mySugr® app users, who met the inclusion criteria (at least two blood glucose logs per day on ≥14 days/month for 3 months with at least one insulin log entry). Change in mean estimated HbA1c (eHbA1c) was assessed over 3 months compared with baseline, analyzed globally, and stratified by diabetes type, country of origin, and World Bank region. A linear regression model was fit to study the relationship between country-specific eHbA1c change and socioeconomic factors (gross domestic product [GDP] per capita, health care expenditure [HE], ratio and World Bank region). Results: App use was associated with a significant mean eHbA1c reduction from 7.55% at baseline to 7.19% over 3 months ( P < 0.001). Significant improvements were observed for both type 1 and type 2 diabetes ( P < 0.001) and across geographic regions. A linear model incorporating GDP per capita, HE, World Bank region, and a GDP*HE interaction was able to explain differences between countries to a large degree (adjusted R 2 value = 0.535). Higher GDP and HE were associated with a better eHbA1c improvement, with the HE effect being stronger in high-GDP countries. These results show an improved glycemic control with the app’s use across diverse health care systems and highlight socioeconomic factors that can predict a majority of the outcome differences between countries, offering valuable insights for health economic modeling and informing policy discussions on digital health reimbursement.