Association between mobile health app engagement, and weight loss and glycemic control in adults with Type 2 diabetes and prediabetes – the D’LITE Study
ABSTRACT
Background:
Mobile health apps are increasingly used as early intervention to support behavioral change for diabetes prevention and control, with the overarching goal of lowering its overall disease burden.
Objective:
This prospective cohort study will investigate on app engagement features and its association with weight loss and improved glycemic control among adults with diabetes and pre-diabetes from the intervention arm of Diabetes Lifestyle Intervention using Technology Empowerment (D’LITE) randomized controlled trial.
Methods:
Diabetes and prediabetes participants (n= 171) with median age of 52 years, and BMI of 29·3 kg/m2, who were assigned the Nutritionist Buddy Diabetes app were included. Body weight and HbA1c, were measured at baseline, 3 and 6 months. A total of 476,300 data points on daily app engagement were tracked via the developer’s data and backend dashboard. The app engagement data were analyzed by quartiles and weekly means expressed in days per week. Generalized Mixed Model Analysis was used to determine the associations between the app engagements with percentage weight and HbA1c change.
Results:
The median overall app engagement rate maintained above 90% at 6 months. Participants who were actively engaged in five or more app features were associated with greatest overall weight reduction of 10·6% from baseline (mean difference -6, 95% CI -8.9 to -3.2, P<.001) at 6 months. Adhering to carbohydrate limit >5·9 days/week and choosing healthier food options >4·3 days/week had the most impact, eliciting weight loss of 9·1% (mean difference -3.7, 95% CI -6.8 to -0.7, P<.001) and 8·8% (mean difference -4.2, 95% CI -7.1 to -1.3, P<.008) respectively. Those who had complete meal log >5·1 days per week or kept within their carbohydrate limit >5·9 days per week each achieved greater HbA1c reductions of 1·2% (SD 1.5) as compared to 0·2% (SD 0.6) in the reference groups who utilized the features <1·1 or ≤ 2·5 days per week, respectively.
Conclusions:
Higher app engagement led to greater weight loss and HbA1c reduction among adults with Type 2 diabetes and prediabetes. Clinical Trial: ACTRN12617001112358, anzctr.org.au
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