Published on in Vol 11 (2023)

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Methodological Considerations for a Diabetes Family-Based eHealth Intervention

Methodological Considerations for a Diabetes Family-Based eHealth Intervention

Methodological Considerations for a Diabetes Family-Based eHealth Intervention

Letter to the Editor

1Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic

2School of Nursing and Health Sciences, University of Sunderland, Sunderland, United Kingdom

3Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom

4Leeds Institute of Cardiovascular and Medicine, University of Leeds, Leeds, United Kingdom

*all authors contributed equally

Corresponding Author:

Jan Brož, PhD

Department of Internal Medicine

Second Faculty of Medicine

Charles University

V Úvalu 84

Prague, 150 00

Czech Republic

Phone: 420 734738858

Fax:420 22 443 4019


We read with interest the article by Feng et al [1], “The Effectiveness of an eHealth Family-Based Intervention Program in Patients With Uncontrolled Type 2 Diabetes Mellitus (T2DM) in the Community Via WeChat: Randomized Controlled Trial,” published in this journal.

This trial aimed to assess the effectiveness of an eHealth family-based health education intervention for patients with T2DM to improve their glucose control, risk perception, and self-care behaviors.

After 1 year of intervention, patients in the intervention arm showed significantly lower hemoglobin A1c (HbA1c) values and improved several diabetes control–related skills (eg, general diet, special diet, blood sugar testing, foot care, risk knowledge, and personal control).

The authors concluded that the eHealth family-based intervention improved glucose control and self-care activities among patients with T2DM by aiding the implementation of interventions to enhance T2DM risk perceptions among family members. The intervention is generalizable for patients with T2DM using health management systems in community health centers. We applaud the authors in the preparation and execution of the study but have several questions that we feel would benefit the article’s readership.

In our observational study focused on metabolic control in patients with type 1 and type 2 diabetes treated with insulin in the Czech Republic and the Slovak Republic, we found a high clinical inertia resulting in a minimal and clinically insignificant difference in the mean HbA1c within 3 years. Thus, we believe any new intervention targeting a long-term stabilized balance between the health carers’ therapeutic approach and the corresponding patient response is essential and can lead to substantial positive results [2,3].

Based on the 7-point scale, the differences in the individual skills observed are not very large. From the authors’ perspective, which intervention had the most significant effect on changes in HbA1c?

Patients in the intervention group met with their physicians every 3 months. Is information available on the frequency of doctor visits in the control group?

The improvements in HbA1c values in the intervention arm are substantial. They even correspond to possible major changes in treatment (eg, initiation of insulin therapy) [4]. Were treatment changes monitored during the study, as these could be responsible for the HbA1c improvement?

It is also known that patients with higher HbA1c levels benefit more from changes in therapy [4]. A subanalysis of HbA1c changes in correlation with their baseline levels would further contribute to the discussion of the generalizability of the intervention design.

We respectfully suggest considering these remarks, especially if a study continuation is planned.


The article was supported by the Ministry of Health, Czech Republic – conceptual development of research organization, Motol University Hospital, Prague, Czech Republic, 00064203.

Conflicts of Interest

None declared.

  1. Feng Y, Zhao Y, Mao L, Gu M, Yuan H, Lu J, et al. The effectiveness of an eHealth family-based intervention program in patients with uncontrolled type 2 diabetes mellitus (T2DM) in the community via WeChat: randomized controlled trial. JMIR Mhealth Uhealth. Mar 20, 2023;11:e40420. [FREE Full text] [CrossRef] [Medline]
  2. Brož J, Janíčková Žďárská D, Urbanová J, Brabec M, Doničová V, Štěpánová R, et al. Current level of glycemic control and clinical inertia in subjects using insulin for the treatment of type 1 and type 2 diabetes in the Czech Republic and the Slovak Republic: results of a multinational, multicenter, observational survey (DIAINFORM). Diabetes Ther. Oct 2018;9(5):1897-1906. [FREE Full text] [CrossRef] [Medline]
  3. Reach G, Pechtner V, Gentilella R, Corcos A, Ceriello A. Clinical inertia and its impact on treatment intensification in people with type 2 diabetes mellitus. Diabetes Metab. Dec 2017;43(6):501-511. [FREE Full text] [CrossRef] [Medline]
  4. Brož J, Janíčková Ždárská D, Štěpánová R, Kvapil M. Addition of basal insulin to oral antidiabetic agents in patients with inadequately controlled type 2 diabetes leads to improved HbA1c levels: metabolic control, frequency of hypoglycemia, and insulin titration analysis as results of a prospective observational study (BALI Study). Diabetes Ther. Apr 2019;10(2):663-672. [FREE Full text] [CrossRef] [Medline]

HbA1c: hemoglobin A1c
T2DM: type 2 diabetes mellitus

Edited by T Leung; This is a non–peer-reviewed article. submitted 02.05.23; accepted 28.08.23; published 18.09.23.


©Jan Brož, Matthew D Campbell, Pavlína Krollová, Juraj Michalec. Originally published in JMIR mHealth and uHealth (, 18.09.2023.

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