JMIR Publications

ABSTRACT

Background:

Type 2 diabetes is increasingly prevalent in society in part due to behavioural issues, with increased sedentary behaviour, reduced exercise, and consumption of foods with a high glycaemic index being major contributors. There is strong evidence for the efficacy of mobile apps to promote behaviour change and lifestyle improvements in people with type 2 diabetes. Many mobile phone applications (apps) have been created to help monitor the condition of people with type 2 diabetes, and to inform them about their health. Some of these digital interventions involve patients using apps on their own, or in conjunction with healthcare professionals.

Objective:

This study set out to test the acceptability to patients with type 2 diabetes of receiving app-based daily physician’s feedback informed by continuous monitoring of their activity, food choices and glucose profiles, with the aim of encouraging healthier behaviours. The GLOOK! app was designed and developed by an academic research team and pilot-tested in an Australian public hospital.

Methods:

Fifteen patients diagnosed with type 2 diabetes wore a glucose monitor and an Apple Watch for 12 days. Uploaded data were integrated into the GLOOK! app on the patients’ smartphone, which also enabled the recording of activity and food consumed. A physician provided daily feedback to each individual through the app, based upon their data from each of the 12 days. At the beginning and the end of the study, data were collected on vital signs, anthropometry, HbA1c, fructosamine, and fasting lipids. Participants were also interviewed at the beginning and the end of the study to assess acceptability of the intervention, and to assess the potential impact of the intervention on promoting positive behaviour change.

Results:

Over the 12 days of the study, there was a significant reduction in HbA1c of 0.22%. There were favourable changes in fructosamine and lipid fractions but none reached significance. There was a fall in body weight of 0.65 kilograms and falls in blood pressure and pulse rate that did not reach significance. The feedback on the GLOOK! system was positive. 87% of participants were enthusiastic about continuing to use the app system if some of the usability and reliability aspects were improved. All participants regarded the personalized physician’s feedback as supportive and helpful in their understanding of their health behaviour. 27% felt that using the system encouraged long-term behaviour change.

Conclusions:

A mobile app system that gives people with type 2 diabetes daily physician-generated personalised feedback can produce favourable changes in glycaemic and cardiovascular risk parameters even in the short term and can encourage better self-management of their condition. Study participants found the experience of using the mobile app system acceptable and were motivated to establish longer term lifestyle improvements through behaviour change.