{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T22:04:51Z","timestamp":1783980291566,"version":"3.55.0"},"reference-count":70,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patient-reported outcomes in digital health solutions can offer patients with type 1 diabetes an opportunity to voice their needs in outpatient care, enabling clinicians to tailor support. Evidence on long-term health impact and routine integration of such digital solutions outside controlled settings is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to compare a flexible digital supplement to outpatient care for type 1 diabetes (DigiDiaS) with usual care over 1 year, with self-management as the primary outcome and glycemic control and well-being as secondary outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This longitudinal real-world observational pre-post study was conducted at the Endocrinology Department of Akershus University Hospital in Norway. Adults with type 1 diabetes were recruited consecutively from October 2022 to October 2023 and could choose either the digital mobile health (mHealth)\u2013based outpatient care model\u2014\u201cDigiDiaS\u201d care\u2014or usual care. DigiDiaS care is delivered via a smartphone app and includes a messaging service; patient-reported outcome\u2013based preconsultation questionnaires; video, telephone, and in-person consultations; and an individually tailored information section. Outcome data comprised self-reported measures, clinical data extracted from electronic medical records, the national diabetes registry, and the digital platform. Data were collected at baseline and at the 1-year follow-up. Change in self-management (Patient Activation Measure short version [PAM-13]; primary outcome) and the secondary outcomes well-being (Five Well-Being Index [WHO-5]) and glycemic control (glycated hemoglobin [HbA1c]) were analyzed using a generalized linear model. Utilization of the digital solution and health care services was also explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 237 patients, with 185 (78%) opting for DigiDiaS care and 52 (22%) for usual care. At the follow-up, most participants (145\/178, 81%) in the DigiDiaS care group used the digital solution. The messaging service was the most utilized feature with 592 messages sent collectively (median 1, min-max 0-57). There were no statistically significant between-group differences in change from baseline to follow-up in self-management (mean difference 1.18, 95% CI \u20135.2 to 7.6; P=.72), glycemic control (HbA1c mean difference \u20132.1, 95% CI \u20136.6 to 2.4; P=.36), or well-being (mean difference 1.9, 95% CI \u20133.1 to 6.9; P=.46). Health care utilization did not differ between the groups, including participation in one or more individual consultations during the 1-year follow-up (DigiDiaS care: 159\/178, 89%; usual care: 42\/50, 84%; P=.30) or appointment cancellations (DigiDiaS care: 64\/91, 70%; usual care: 13\/18, 72%; P=.20).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This real-world pragmatic observational comparison under routine conditions demonstrates that reorganizing outpatient care for patients with type 1 diabetes into a flexible digital model, DigiDiaS care, did not result in statistically significant between-group differences in health outcomes, including self-management, glycemic control, and well-being, compared with usual care. Over 80% of participants in DigiDiaS care utilized the digital solution, with patient-initiated asynchronous messaging as the most frequently used feature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>International Registered Report Identifier (IRRID)<\/jats:title>\n                    <jats:p>RR2-10.2196\/52766<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/94782","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T21:15:06Z","timestamp":1783977306000},"page":"e94782","source":"Crossref","is-referenced-by-count":0,"title":["Digital Outpatient Care for Patients With Type 1 Diabetes (DigiDiaS): Pragmatic Observational Pre-Post Study"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0828-8582","authenticated-orcid":false,"given":"Ingeborg","family":"Spildo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1314-7813","authenticated-orcid":false,"given":"Heidi","family":"Holmen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2025-6663","authenticated-orcid":false,"given":"Annesofie","family":"Lunde Jensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8947-8649","authenticated-orcid":false,"given":"Milada","family":"Hagen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2499-5826","authenticated-orcid":false,"given":"Tone","family":"Singstad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2158-786X","authenticated-orcid":false,"given":"Jacob Andreas","family":"Winther","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9520-1408","authenticated-orcid":false,"given":"Eirik","family":"Arsand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2385-2452","authenticated-orcid":false,"given":"Astrid","family":"Torbj\u00f8rnsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.2337\/dc16-2053"},{"key":"ref2","unstructured":"HirschIBEmmettMDiabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: clinical features, evaluation, and diagnosisUpToDate20252026-06-26https:\/\/www.uptodate.com\/contents\/diabetic-ketoacidosis-and-hyperosmolar-hyper glycemic-state-in-adults-clinical-features-evaluation-and-diagnosis"},{"key":"ref3","year":"2024","journal-title":"Standards of Care in Diabetes 2025"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1111\/dme.14216"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2022.108232"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s13300-023-01513-2"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2024.108377"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1177\/01410768231152222"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1111\/hex.12346"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.4137\/HSI.S11093"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-019-1190-x"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1186\/s41687-018-0061-6"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2020.0375"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.2196\/63639"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2023-003628"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1111\/scs.13154"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1111\/dme.14791"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1186\/s41687-023-00564-0"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1177\/1460458220942649"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.2196\/52766"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.2196\/73708"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.2196\/70301"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"ref24","unstructured":"National Professional Guideline for Diabetes internetNorwegian Directorate of Health20162026-01-06https:\/\/www.helsedirektoratet.no\/retningslinjer\/diabetes"},{"key":"ref25","unstructured":"Instructions for use - 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