JMIR Publications

ABSTRACT

Background:

China’s diabetes epidemic faces critical gaps in glycemic control, with only 50.1% achieving HbA1c targets in 2021. Conventional interventions struggle with scalability in primary care, particularly for vulnerable populations.

Objective:

The study aimed to evaluate the WeChat-based health education tool (“WeWalk” mini program, “Bayu Health” public account and WeChat group) for improving glycemic control in community-dwelling T2DM patients.

Methods:

This multicenter randomized controlled trial enrolled 600 adults with type 2 diabetes from three Chongqing communities, randomly allocating participants 1:1 to either a 12-week WeChat-based intervention (n=300) or a control group (n=300) in September 2020. The control group received four face-to-face traditional health education sessions, while the intervention group participated in a digital program: a 4-week course (30 modules) followed by an 8-week practical implementation (60 behavioral tasks). At baseline and 12 weeks after the intervention began, both groups were examined in terms of HbA1c, fasting blood glucose (FBG) as the primary outcomes, as well as the variables such as blood lipid profile, blood pressure, physical fitness-related indices as secondary outcomes. Longitudinal glycemic control was assessed through triplicate FBG measurements extracted from standardized electronic health records at the 2-year follow-up. Independent t-tests or Mann-Whitney U tests were used to assess changes from baseline to follow-up between groups.

Results:

92.7% (556/600) of the participants completed the 12-week follow-up visit. The WeChat-based intervention demonstrated superior glycemic control outcomes, with intervention participants achieving a 0.59% greater HbA1c reduction compared to controls (-0.03% vs 0.56%; P<0.01) and significant FBG improvements (-0.69 vs 0.00 mmol/L, Δ=0.69, P<0.01). Subgroup analysis revealed that the WeChat-based health education was significantly effective in diabetic patients with a disease course of <10 years, education of junior high or below, and family income of <50,000 ¥/year. These benefits persisted through 2-year follow-up, where the intervention group maintained lower FBG levels (6.87 vs 7.35 mmol/L, P<0.01).

Conclusions:

The WeChat-based health education was beneficial for glycemic control in patients with T2DM in the primary health care settings. Furthermore, the long-term effects of the WeChat-based health education intervention need to be explored. Clinical Trial: Chinese Clinical Trial Registry ChiCTR2300071926.