A Novel User Utility Score for Diabetes Management Using Digital Health Technology: Results from a Randomized Controlled Trial of a Tailored Mobile Coaching System (Preprint)

BACKGROUND Digital health technology has been developed to support diabetes self-management, but its effectiveness could depend on patient engagement. OBJECTIVE We examined the relationship between novel user utility score (UUS) developed to measure patient engagement and glycemic control among a policyholders with type 2 diabetes. METHODS In 72 participants, we analyzed the association of health outcomes over 12 months with UUS for the first 3 months through a sub-analysis of results from a 12-month randomized controlled trial of a tailored mobile coaching (TMC) system. The UUS was calculated as the sum of scores for four major core components (range 0–8): frequency of self-monitoring blood glucose testing, dietary and exercise records, and message reading rate. RESULTS Participants were divided into two groups: UUS:0–4 (n = 38) and UUS:5–8 (n = 34). Change from baseline in HbA1c was greater with the UUS:5–8 group than the UUS:0–4 group at 3 months (-1.0% vs. -0.37%; P = 0.018), and was sustained through 6 (-0.99 vs. -0.32; P = 0.013) and 12 months (-0.92 vs. -0.33; P = 0.049). Significant differences in changes in HbA1c between the groups were observed over the 12-month period (P for trend < 0.0001). Changes in HbA1c at 3, 6 and 12 months were significantly associated with UUS. CONCLUSIONS UUS as a measure of patient engagement was associated with changes in HbA1c and could be used to predict improved glycemic control in diabetes management using a TMC system in type 2 diabetes. CLINICALTRIAL NCT03033407

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Diabetes conversation map - a novel tool for diabetes management self-efficacy among type 2 diabetes patients in Pakistan: a randomized controlled trial

BMC Endocrine Disorders ◽

10.1186/s12902-020-00572-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Rubina Qasim ◽

Sarfaraz Masih ◽

Mohammad Tahir Yousafzai ◽

Hakim shah ◽

Abdul Manan ◽

...

Keyword(s):

Type 2 Diabetes ◽

Randomized Controlled Trial ◽

Self Efficacy ◽

Diabetes Management ◽

Controlled Trial ◽

Randomized Controlled ◽

Conversation Map ◽

Diabetes Patients

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A Novel User Utility Score for Diabetes Management Using Tailored Mobile Coaching: Secondary Analysis of a Randomized Controlled Trial

JMIR mhealth and uhealth ◽

10.2196/17573 ◽

2021 ◽

Vol 9 (2) ◽

pp. e17573

Author(s):

Min-Kyung Lee ◽

Da Young Lee ◽

Hong-Yup Ahn ◽

Cheol-Young Park

Keyword(s):

Randomized Controlled Trial ◽

Glycemic Control ◽

Mobile Health ◽

Patient Engagement ◽

Utility Score ◽

Diabetes Management ◽

Controlled Trial ◽

Self Management ◽

Glucose Testing ◽

Randomized Controlled

Background Mobile health applications have been developed to support diabetes self-management, but their effectiveness could depend on patient engagement. Therefore, patient engagement must be examined through multifactorial tailored behavioral interventions from an individual perspective. Objective This study aims to evaluate the usefulness of a novel user utility score (UUS) as a tool to measure patient engagement by using a mobile health application for diabetes management. Methods We conducted a subanalysis of results from a 12-month randomized controlled trial of a tailored mobile coaching (TMC) system among insurance policyholders with type 2 diabetes. UUS was calculated as the sum of the scores for 4 major core components (range 0-8): frequency of self-monitoring blood glucose testing, dietary and exercise records, and message reading rate. We explored the association between UUS for the first 3 months and glycemic control over 12 months. In addition, we investigated the relationship of UUS with blood pressure, lipid profile, and self-report scales assessing diabetes self-management. Results We divided 72 participants into 2 groups based on UUS for the first 3 months: UUS:0-4 (n=38) and UUS:5-8 (n=34). There was a significant between-group difference in glycated hemoglobin test (HbA1c) levels for the 12-months study period (P=.011). The HbA1c decrement at 12 months in the UUS:5-8 group was greater than that of the UUS:0-4 group [–0.92 (SD 1.24%) vs –0.33 (SD 0.80%); P=.049]. After adjusting for confounding factors, UUS was significantly associated with changes in HbA1c at 3, 6, and 12 months; the regression coefficients were –0.113 (SD 0.040; P=.006), –0.143 (SD 0.045; P=.002), and –0.136 (SD 0.052; P=.011), respectively. Change differences in other health outcomes between the 2 groups were not observed throughout a 12-month follow-up. Conclusions UUS as a measure of patient engagement was associated with changes in HbA1c over the study period of the TMC system and could be used to predict improved glycemic control in diabetes self-management through mobile health interventions. Trial Registration ClinicalTrial.gov NCT03033407; https://clinicaltrials.gov/ct2/show/NCT03033407

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Digital Health Coaching for Type 2 Diabetes: Randomized Controlled Trial of Healthy at Home

Frontiers in Digital Health ◽

10.3389/fdgth.2021.764735 ◽

2021 ◽

Vol 3 ◽

Author(s):

Kimberly R. Azelton ◽

Aidan P. Crowley ◽

Nicholas Vence ◽

Karin Underwood ◽

Gerald Morris ◽

...

Keyword(s):

Insulin Resistance ◽

Type 2 Diabetes ◽

Randomized Controlled Trial ◽

Digital Health ◽

Controlled Trial ◽

Health Coaching ◽

Effective Control ◽

Randomized Controlled ◽

At Home

Digital health coaching is an intervention for type 2 diabetes mellitus (T2DM) that has potential to improve the quality of care for patients. Previous research has established the efficacy of digital interventions for behavior change. This pilot study addresses a research gap in finding effective and accessible behavioral interventions for under-resourced individuals with T2DM. We examined the impact of Healthy at Home, a 12-week phone and SMS-based (short message service) digital health coaching program, on insulin resistance which is an upstream marker for T2DM progression. We compared this intervention to usual diabetic care in a family medicine residency clinic in a randomized controlled trial. Digital health coaching significantly improved participants' calculated Homeostatic Model Assessment for Insulin Resistance (HOMA2-IR) by −0.9 ± 0.4 compared with the control group (p = 0.029). This significance remained after controlling for years diagnosed with T2DM, enrollment in Medicaid, access to food, baseline stage of change, and race (p = 0.027). Increasing access to digital health coaching may lead to more effective control of diabetes for under-resourced patients. This study demonstrates the potential to implement a personalized, scalable, and effective digital health intervention to treat and manage T2DM through a lifestyle and behavioral approach to improve clinical outcomes (http://clinicaltrials.gov, NCT04872647).

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