JMIR Publications

ABSTRACT

Background:

With increasing type 2 diabetes mellitus (T2DM) prevalence, mobile health (mHealth) interventions have shown promising results in supporting diabetes management and improving T2DM outcomes. With the COVID-19 pandemic, the world is increasingly embracing digital solutions to limit in-person interactions.

Objective:

The study objective was to evaluate a personalized mHealth-anchored intervention in its effectiveness and feasibility for improving glycemic control and enhancing care experience in diabetes management. The program was coincidentally implemented during the national-level partial lockdown for COVID-19 in Singapore, allowing for a timely study of the use of mHealth for chronic disease management.

Methods:

Thirty patients were enrolled from the Singapore Armed Forces and offered a 3-month intervention program in addition to the usual care they received for their T2DM or prediabetes. The program was standardized to include the following components: (1) in-person consultation with dietitian, (2) in-person review with diabetes specialist doctor, (3) one continuous glucose monitoring device in the first two weeks, (4) access to the mobile app that allows food and physical activity tracking, and communication via text messaging with the dietitian and doctor, and (5) context-sensitive digital health coaching provided by the dietitian over the mobile app. Medical advice was rendered to patients as needed when they experienced hypoglycemia requiring medication adjustments, or when they required adjustment of medications. Measurements of weight, height, and glycated hemoglobin A (HbA1c) were conducted at the two in-person visits at the start and end of the program. At the end of the program, patients were asked to complete a short survey to understand the motivation for joining the program, their feedback, and suggestions for improvement.

Results:

Twenty-one patients completed the program and were included in the final analyses. Nine participants were lost to follow up and did not have the full dataset available for the final analyses. There were no significant differences in any of the baseline characteristics between the patients that were excluded and those included in the final analyses. For all 21 completers, mean HbA1c decreased from 7.6% to 7.0% (P = .004). There were no severe hypoglycemia events (glucose level < 3.0 mmol/L) reported. Mean weight decreased from 76.8 kg to 73.9 kg (P < .001), which was a mean decrease of 3.5% from the baseline weight. Mean body mass index decreased from 27.8 kg/m2 to 26.7 kg/m2 (P < .001). Patients rated a mean of 9.0 out of 10 on the Likert scale for both satisfaction questions. For the Yes-No question on benefit of the program, 100% of the patients selected “Yes”.

Conclusions:

Results of this study suggest that the mHealth-anchored intervention program was able to produce significant reductions in body weight and HbA1c in individuals with T2DM, when added to usual care. A program with a strong mHealth component can overcome challenges posed by COVID-19 to chronic disease management, including disruptions to in-person healthcare access.