Effect of a Smartphone App on Weight Change and Metabolic Outcomes in Asian Adults With Type 2 Diabetes
| Autor: | Lim, Su Lin, Ong, Kai Wen, Johal, Jolyn, Han, Chad Yixian, Yap, Qai Ven, Chan, Yiong Huak, Chooi, Yu Chung, Zhang, Zhi Peng, Chandra, Cheryl Christine, Thiagarajah, Anandan Gerard, Khoo, Chin Meng |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: | |
| Zdroj: | JAMA Network Open |
| ISSN: | 2574-3805 |
| Popis: | Key Points Question What is the effect of a culturally contextualized smartphone-based lifestyle intervention on weight change and metabolic outcomes in Asian adults who have overweight or obesity and type 2 diabetes compared with usual care? Findings In this randomized clinical trial of 204 adults with type 2 diabetes, the use of a smartphone app tracking personal health data and using integrated behavioral modification strategies led to significantly greater reductions in weight and hemoglobin A1c, along with a significantly greater proportion of patients with a reduction in diabetes medication dosages compared with usual care at 6 months. Meaning These findings suggest that a mobile health lifestyle intervention has the potential to improve weight and glycemic outcomes among individuals who have overweight or obesity in an Asian population with type 2 diabetes. This randomized clinical trial of adults in Singapore with type 2 diabetes and overweight or obesity assessed whether use of a smartphone app with behavior modification strategies affected weight change and metabolic outcomes. Importance Lifestyle interventions are effective in diabetes management, with smartphone apps that manage health data and dietary and exercise schedules gaining popularity. However, limited evidence from randomized clinical trials exists regarding the effectiveness of smartphone-based interventions among Asian adults with type 2 diabetes. Objective To compare the effects of a culturally contextualized smartphone-based intervention with usual care on weight and metabolic outcomes. Design, Setting, and Participants This randomized clinical trial conducted at multiple primary care centers in Singapore included 305 adults with type 2 diabetes and body mass index (BMI) of 23 or greater who had literacy in English and smartphone access. Participants were recruited between October 3, 2017, and September 9, 2019, and were randomly assigned (1:1; stratified by gender, age, and BMI) to intervention (99 participants) or control (105 participants) groups. Participants’ data were analyzed using intention-to-treat analysis. Interventions Both control and intervention participants received diet and physical activity advice from a dietitian at a baseline face-to-face visit. Intervention participants additionally used a smartphone app to track weight, diet, physical activity, and blood glucose and then communicated with dietitians for 6 months. Main Outcomes and Measures Primary outcome was change in body weight, while secondary outcomes were changes in hemoglobin A1c (HbA1c), fasting blood glucose, blood pressure, lipids, and diet. Post hoc analyses included glycemic changes in the subgroup with HbA1c levels of 8% or greater and diabetes medication changes. Results Among the 204 randomized participants (mean [SD] age, 51.2 [9.7] years; 132 [64.7%] men), baseline mean (SD) BMI was 30.6 (4.3). Compared with the control group, intervention participants achieved significantly greater reductions in weight (mean [SD] change, −3.6 [4.7] kg vs −1.2 [3.6] kg) and HbA1c levels (mean [SD] change, −0.7% [1.2] vs −0.3% [1.0]), with a greater proportion having a reduction in diabetes medications (17 participants [23.3%] vs 4 participants [5.4%]) at 6 months. The intervention led to a greater HbA1c reduction among participants with HbA1c levels of 8% or higher (mean [SD] change, −1.8% [1.4] vs −1.0% [1.4]; P = .001). Intergroup differences favoring the intervention were also noted for fasting blood glucose, diastolic blood pressure, and dietary changes. Conclusions and Relevance In this study, a smartphone-based lifestyle intervention was more effective in achieving weight and glycemic reductions among Asian adults with type 2 diabetes compared with usual care, supporting the use of apps in lifestyle intervention delivery. Trial Registration anzctr.org.au Identifier: ACTRN12617001112358 |
| Databáze: | OpenAIRE |
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