This first-of-its-kind study reports on the largest and most comprehensive analysis to date to assess the factors associated with social media engagement among global diabetes researchers. The dataset included 20,614,515 tweets and 44,125 scientific publications, authored by 2686 unique global diabetes researchers over a 2-year period. We demonstrated that among digitally activated diabetes researchers, diabetes-related tweet rates were over three times greater than diabetes-related publication volumes. While researchers on average benefited from 157 academic co-authors, they also had an average of 1931 Twitter followers, suggesting digital media may improve the reach of their research. Those with the most followers had a significantly greater likelihood of publishing diabetes-related Twitter content and having this content shared and commented on by others in the diabetes scientific community. Furthermore, those who published the most academic publications regarding specific topics, including type 1 versus type 2 diabetes, insulin, and paediatrics, were also significantly more likely to tweet about these subjects compared with others with lower publication volumes. Interestingly, those with the greatest number of academic co-authors, those with the most first and last authorships, and those publishing the most research (all proxies for research experience and authority) were no more likely to post diabetes content via Twitter (both during and outside of conferences) or have their content commented on or shared than those with fewer publications, first or last authorships or co-authors, respectively. Finally, those most likely to be classed as ‘KOLs’, with the most publications per month, were significantly less likely to use social media, and when they did, they were significantly less likely to have their content commented on and shared.

The strengths of this study include the vast and novel dataset that was compiled and used for the analysis, which included the identification of over 20 million tweets and 44,000 diabetes-related publications, which were then mapped to 2686 specific global diabetes researchers. To date, no prior study has compared the bibliometric and social media use patterns at an individual level by linking bibliometric and social media records, especially so within a healthcare setting. This study therefore provides previously unreported findings from a novel research methodology, examining the factors predicting digital engagement among those publishing research in the therapeutic area of diabetes.

There are also several weaknesses of this study that should be considered. First, while every effort was made to ensure that the majority of digitally active diabetes publishers were included, we cannot guarantee this. We used a data collection period of 2 years. It is plausible that otherwise frequent academic publishers may have experienced a lull or a sabbatical over this period, including parental leave or investment in longer-term research, including randomised controlled trials (RCTs), which may have temporarily reduced their publication volume and therefore omitted them from the analysis. Similarly, while retweet and comment rates were considered for digital mentions, no metric for the success of, reach, or interest in academic publications was included. Use of Altmetric or similar measures of publication interest may have added to the analysis by providing another dimension to the academic outputs analysed.

Second, as the purpose of this study was to compare bibliometric and social media use among those using both channels, the study cannot and did not identify factors leading to increased frequency of use among those currently only communicating via social media. These individuals who are disproportionately more likely to be at an earlier point in their careers and who are yet to be named as co-authors on diabetes-related academic manuscripts may have been missed as a result of the prerequisite to have published at least one scientific manuscript. Another limitation resulting from this is the lack of recognition of a potential confounding variable, digital influence. Social network analysis may have highlighted who was most digitally influential and used this as a variable in predicting Tweet, retweet and comment rates. Further research should aim to determine the role of social influence in digital activity.

Finally, while the rapid automatic keyword extraction algorithm used to identify and tag diabetes-related mentions was highly sensitive and was based on approximately 300 search terms in total (Box S1, Online Resource 1), including patient outcomes and brand names (including market variations), we cannot guarantee that all mentions were retrieved and included in the analysis. This is particularly likely where patients and/or HCPs used abbreviations or commonly known shorthand for treatments or outcomes under consideration, or in the event of spelling errors. However, there is no reason to believe that this may have affected any one aspect of the analysis more than any other, therefore making it unlikely to affect the analysis, as, in the event that mentions were omitted, these were likely to be missing at random.

The findings of several previous studies not specific to diabetes have suggested that HCPs often use social media to refer to experts or ‘KOLs’ for better decision processes and outcomes [15,16,17], enabling access to KOLs and their opinions that may not have otherwise been possible. However, our findings do not agree with this suggestion presented in previous studies. Rather, we learned that all things being equal, not only do the most frequently and influential HCPs use social media less often but when they do they are significantly less likely to have their content shared or interacted with by the diabetes scientific community. The reasons behind this finding may be several. First, the prior studies referred to, although among the most recent examining KOL influence, took place between 2006 and 2012. It is therefore possible that in the time since these publications, scientific communities have improved and matured, and observed that useful scientific information is not solely produced by the most influential and well-published. Second, the lack of engagement with digital content provided by KOLs could be a natural side effect of not wanting to say the ‘wrong thing’ or provide an opposing opinion to persons of influence. Third, it is likely that given the lower utilisation of digital media by high-publishing HCPs, they have put less effort into cultivating their digital networks. The number of followers a researcher has on Twitter was consistently shown to be predictive of both retweet and comment rates, therefore assisting higher-publishing researchers in growing their digital networks may prove useful in ensuring that their messaging is more widely received.

This finding that the most established and highest-publishing HCPs were less likely to utilise social media for the purposes of networking, sharing knowledge and engaging in continued medical education, agrees with the findings of previous studies [18, 19]. A recent survey highlighted that 29.1% of healthcare workers use social media once a day to exchange medical knowledge with their peers, with 24.6% using it multiple times a day [6].Another recent study demonstrated that HCPs typically spend 1 h per day using social media, with those under the age of 40 years far more involved than those above 40 years of age (p < 0.05) [10]. The factors driving social media use among HCPs have been extensively researched, and the perceived usefulness of content provided via digital media has previously been shown to be a key predictor of social media use [6]. Among those earlier in their careers, a lot can be learned from social media and from the views of more experienced researchers, which in essence can create a virtual network resembling a living advertisement board. This engaging medium has enormous potential for establishing relationships and disseminating information among physicians, their colleagues, and patients [19]. Previous studies have shown that these ‘virtual communities of practice’ are a key factor in drawing HCPs into using digital media, with improved knowledge sharing among colleagues just one of the benefits of these groups [20].One key disadvantage to date has been that many of these online groups are closed and private, confining knowledge to specific users and preventing the dissemination of information within a multidisciplinary environment to help improve performance and outcomes. However, the use of open Twitter virtual communities is likely a significant draw, especially to researchers who still have a lot to learn.

Simplistically assuming age as a proxy for experience, this should be considered when planning digital interactions and performing market landscaping, as it is likely to be the lesser-known HCPs who will provide the greatest volume of insights from a digital listening perspective, and also most likely to consume and share any content provided by industry. Digital media is therefore likely to continue to increase in popularity and relevance, especially as current medical students and early-career HCPs, who are generally more digitally engaged [10, 21], continue their careers into more senior and influential roles. As digital becomes more of a mainstay of scientific communication, engaging with and maintaining awareness of the beliefs of these digitally active HCPs may not only provide a significant medical return on investment but also quantify this return with direct linked metrics. This may be of particular value from a future brand planning and lifecycle management perspective, particularly in identifying and communicating practice gaps, which may provide support to convince government health divisions to take action and update clinical practice guidelines.

As the world transitions from the current COVID-19 landscape, it is apparent that hybrid attendance at conferences is becoming increasingly popular and is unlikely to change any time soon [1]. Digital involvement in these events not only reduces financial costs for those attending but also increases access for those who are looking after children or family, or in fact from more remote locations, who are equally in need of keeping on top of the most up-to-date science. Previous evidence has shown that the use of open online platforms and virtual communities such as Twitter is gaining popularity at health care conferences by allowing attendees to interact with one another and with their greater social networks, facilitating the sharing of information and ideas [7]. The ASCO annual meeting saw an increase in tweets from 10,475 in 2012 to 44,034 in 2014 [8] and 83,078 in 2019 (Twitter data). Our study included tens of thousands of mentions from the ADA and EASD conferences. We found that contrary to ‘outside conference’, there was no significant difference in digital engagement among researchers of all types. Whereas outside of conferences it was lesser known, and lesser published HCPs who were most likely to be digitally active, during conferences this gap reduced, suggesting that KOLs save their digital media use for these big events but are less likely to engage outside of events. This can be interpreted in one of two ways. First, that medical and commercial teams should acknowledge the different times when HCPs utilise digital media, allowing an evidence-based means of collecting HCP perspectives over time, and second, that industry should consider branching out to lesser-known HCPs for the purposes of symposia and presentations, as they are equally likely as KOLs to promote (and be promoted) at events.