Accepted for/Published in: JMIR Research Protocols
Date Submitted: Mar 17, 2025
Date Accepted: Sep 2, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
BALANCE PROGRAMME: A Digital Therapeutic Solution for Type 2 Diabetes Management
ABSTRACT
Background:
Type 2 diabetes mellitus (T2DM) is a growing global health issue. In 2016, 9.7% of Bruneian adults aged 18-69 have diabetes, and it was the third leading cause of death. Effective self-management can mitigate complications requiring healthcare interventions and thereby reduce healthcare costs. Leveraging on digital technology, Brunei Darussalam has deployed a comprehensive, national mobile health (mHealth) platform, BruHealth; synced with the Brunei Health Information Management System (BruHIMS), enabling patients to access their health records in real time, schedule appointments and explore medical articles like nutrition and lifestyle. A Digital Therapeutics (DTx) module focused on the management of Type 2 Diabetes Mellitus (DM DTx) has been developed in Brunei Darussalam. DM DTx consists of a digital lifestyle intervention module which is integrated into the BruHealth application, and a separate Healthcare Professional (HCP) Portal for health coaches to manage their patients. The intervention, named BALANCE Programme, runs for 16 weeks and focuses on enabling self-management. This study explores the effectiveness of DM DTx in managing T2DM through digital lifestyle interventions. As there is a predominant Muslim population, this study additionally aims to gain insight into fasting practices for Muslim participants with T2DM.
Objective:
The primary objective is to determine the proportion of participants who achieve a 0.6% reduction in HbA1c after 16 weeks. Secondary objectives include evaluating changes in HbA1c, fasting lipid profile, blood glucose, BMI, and waist circumference; analysing participant feedback; and examining the fasting experience of Muslim participants with T2DM during Ramadan.
Methods:
This is a single-arm, non-randomized intervention study. Participants with T2DM will undergo an online 16-week lifestyle management module (the BALANCE programme) on BruHealth, which includes diabetes self-management education (DSME), personalised lifestyle recommendations, and health coach support. Anthropometric measurements (BMI and waist circumference) and blood tests (HbA1c, fasting blood glucose, lipid profile) will be taken at baseline and after the intervention for comparison.
Results:
Recruitment is currently ongoing. As of 31st January 2025, 334 participants have been enrolled into the programme and 61 participants have completed the programme.
Conclusions:
Self-management mHealth applications are a promising tool for chronic disease management, including T2DM. The BALANCE Programme will be the first national scale study to investigate the effectiveness and feasibility of a fully online T2DM intervention. The localisation to a region’s population can create a solution that is fit for purpose and contributes to improved health outcomes.
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