Self-management of diabetes through smartphone heath app engagement appears to bring positive changes in disease outcomes such as weight and blood sugar, according to data from the Diabetes Lifestyle Intervention using Technology Empowerment (D’LITE) study.
In a cohort of Singaporean adults with diabetes and prediabetes, frequent use of the Nutritionist Buddy (nBuddy) Diabetes app facilitated marked reductions in weight and HbA1c over 6 months. Weight decreased by as much as 10.6 percent from baseline for participants who engaged in ≥5 vs <5 app features (mean difference, −6 percent, 95 percent confidence interval [CI], −8.9 to −3.2; p<0.001). Meanwhile, HbA1c dropped by 1.0–1.4 percent among participants with diabetes with greater app engagements. [JMIR Diabetes 2022;7:e35039]
These findings are in line with previous reports that higher app engagement leads to better health outcomes and is the primary determinant in successful weight loss, according to investigators from the National University Singapore. [J Med Internet Res 2017;19:e160; Transl Behav Med 2017;7:277-285]
“We postulate that the more time spent on the app, the participants are more likely to engage with learning, self-monitoring, and health improvement behaviours that in turn [change the patients’ overall approach to their health, enabling] better self-management capability and commitment,” they pointed out. [Int J Behav Nutr Phys Act 2016;13:127]
Personal health assistant
Conceptualized based on a theoretical behavioural model, the nBuddy Diabetes app has multiple features that support a user’s self-management efforts, including meal logging, calorie and carbohydrate limit alerts, and step tracking. Using data from these features, the app sends real-time prompts that remind its user to make a healthier meal choice, with automated suggestions of culturally appropriate food alternatives. [JAMA Netw Open 2021;4:e2112417]
Additionally, the app integrates tracking features such as weight charting and self-monitoring of blood glucose (SMBG), fasting, and random blood glucose. It also allows two-way communication between the dietitian and participants to enable individual lifestyle modification and coaching via a chat function.
In the study, app engagement over 6 months was defined as actively using the individual app features, such as entering a body weight value as opposed to just browsing or scrolling through the app. The cutoff used was 75 percent, which is considered a common and realistic uptake as reiterated by similar mobile health (mHealth) studies in the literature. [JMIR Mhealth Uhealth 2020;8:e14802]
The median overall app engagement rate was maintained above 90 percent through 6 months among the 171 diabetes and prediabetes participants (median age 52 years, body mass index 29.3 kg/m2, HbA1c level 6.5 percent) included in the analysis.
Meal logging was one of the commonly used features of the app. Of note, participants with diabetes who had a complete meal log for >5.1 days per week or kept within their carbohydrate limit for >5.9 days per week each saw greater HbA1c reductions of 1.2 percent, as compared with 0.2 percent among those who used the features <1.1 or ≤2.5 days per week, respectively.
Meanwhile, adherence to the carbohydrate limit of >5.9 days per week and choosing healthier food options for >4.3 days per week had the most impact on weight, resulting in reductions of 9.1 percent (p=0.001) and 8.8 percent (p=0.005), respectively.
“Taken together, meal logging should be made part of routine monitoring, similar to SMBG, not just to guide management for patients with diabetes during clinic visits but also as an important behavioural intervention,” according to the investigators.
“It is also important to note that participants communicated with the dietitian through the app every other day… The two-way communication with a dietitian could empower participants to make immediate changes based on the SMBG readings, meal log, and physical activity. Indeed, the engagement with the dietitian through the app was associated with a significant reduction in body weight and HbA1c levels,” they added.
