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A Mobile Lifestyle Management Program (GlycoLeap) for People With Type 2 Diabetes: Single-Arm Feasibility Study.

Publication ,  Journal Article
Koot, D; Goh, PSC; Lim, RSM; Tian, Y; Yau, TY; Tan, NC; Finkelstein, EA
Published in: JMIR Mhealth Uhealth
May 24, 2019

BACKGROUND: Singapore's current prevalence of diabetes exceeds 13.6%. Although lifestyle modification can be effective for reducing the risks for complications of type 2 diabetes mellitus (T2DM), traditional lifestyle interventions are often difficult to administer in the primary care setting due to limited resources. Mobile health apps can address these limitations by offering low-cost, adaptable, and accessible platforms for disseminating lifestyle management interventions. OBJECTIVE: Using the RE-AIM evaluation framework, this study assessed the potential effectiveness and feasibility of GlycoLeap, a mobile lifestyle management program for people with T2DM, as an add-on to standard care. METHODS: This single-arm feasibility study recruited 100 patients with T2DM and glycated hemoglobin (HbA1c) levels of ≥7.5% from a single community health care facility in Singapore. All participants were given access to a 6-month mobile lifestyle management program, GlycoLeap, comprising online lessons and the Glyco mobile phone app with a health coaching feature. The GlycoLeap program was evaluated using 4 relevant dimensions of the RE-AIM framework: (1) reach (percentage who consented to participate out of all patients approached), (2) effectiveness (percentage point change in HbA1c [primary outcome] and weight loss [secondary outcome]), (3) implementation (program engagement as assessed by various participatory metrics), and (4) maintenance (postintervention user satisfaction surveys to predict the sustainability of GlycoLeap). Participants were assessed at baseline and at follow-up (≥12 weeks after starting the intervention). RESULTS: A total of 785 patients were approached of whom 104 consented to participate, placing the reach at 13.2%. Four were excluded after eligibility screening, and 100 patients were recruited. Program engagement (implementation) started out high but decreased with time for all evaluated components. Self-reported survey data suggest that participants monitored their blood glucose on more days in the past week at follow-up compared to baseline (P<.001) and reported positive changes to their diet due to app engagement (P<.001) (implementation). Primary outcome data were available for 83 participants. Statistically significant improvements were observed for HbA1c (-1.3 percentage points, P<.001) with greater improvements for those who logged their weight more often (P=.007) (effectiveness). Participants also had a 2.3% reduction in baseline weight (P<.001) (effectiveness). User satisfaction was high with 74% (59/80) and 79% (63/80) of participants rating the app good or very good and claiming that they would probably or definitely recommend the app to others, respectively (maintenance). CONCLUSIONS: Although measures of program engagement decreased with time, clinically significant improvements in HbA1c were achieved with the potential for broader implementation. However, we cannot rule out that these improvements were due to factors unrelated to GlycoLeap. Therefore, we would recommend evaluating the effectiveness and cost effectiveness of GlycoLeap using a randomized controlled trial of at least 12 months. TRIAL REGISTRATION: ClinicalTrials.gov NCT03091517; https://clinicaltrials.gov/ct2/show/NCT03091517 (Archived by WebCite at http://www.webcitation.org/77rNqhwRn).

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Published In

JMIR Mhealth Uhealth

DOI

ISSN

2291-5222

Publication Date

May 24, 2019

Volume

7

Issue

5

Start / End Page

e12965

Location

Canada

Related Subject Headings

  • Surveys and Questionnaires
  • Singapore
  • Self Report
  • Risk Reduction Behavior
  • Mobile Applications
  • Middle Aged
  • Mentoring
  • Male
  • Humans
  • Glycated Hemoglobin
 

Citation

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Koot, D., Goh, P. S. C., Lim, R. S. M., Tian, Y., Yau, T. Y., Tan, N. C., & Finkelstein, E. A. (2019). A Mobile Lifestyle Management Program (GlycoLeap) for People With Type 2 Diabetes: Single-Arm Feasibility Study. JMIR Mhealth Uhealth, 7(5), e12965. https://doi.org/10.2196/12965
Koot, David, Paul Soo Chye Goh, Robyn Su May Lim, Yubing Tian, Teng Yan Yau, Ngiap Chuan Tan, and Eric Andrew Finkelstein. “A Mobile Lifestyle Management Program (GlycoLeap) for People With Type 2 Diabetes: Single-Arm Feasibility Study.JMIR Mhealth Uhealth 7, no. 5 (May 24, 2019): e12965. https://doi.org/10.2196/12965.
Koot D, Goh PSC, Lim RSM, Tian Y, Yau TY, Tan NC, et al. A Mobile Lifestyle Management Program (GlycoLeap) for People With Type 2 Diabetes: Single-Arm Feasibility Study. JMIR Mhealth Uhealth. 2019 May 24;7(5):e12965.
Koot, David, et al. “A Mobile Lifestyle Management Program (GlycoLeap) for People With Type 2 Diabetes: Single-Arm Feasibility Study.JMIR Mhealth Uhealth, vol. 7, no. 5, May 2019, p. e12965. Pubmed, doi:10.2196/12965.
Koot D, Goh PSC, Lim RSM, Tian Y, Yau TY, Tan NC, Finkelstein EA. A Mobile Lifestyle Management Program (GlycoLeap) for People With Type 2 Diabetes: Single-Arm Feasibility Study. JMIR Mhealth Uhealth. 2019 May 24;7(5):e12965.

Published In

JMIR Mhealth Uhealth

DOI

ISSN

2291-5222

Publication Date

May 24, 2019

Volume

7

Issue

5

Start / End Page

e12965

Location

Canada

Related Subject Headings

  • Surveys and Questionnaires
  • Singapore
  • Self Report
  • Risk Reduction Behavior
  • Mobile Applications
  • Middle Aged
  • Mentoring
  • Male
  • Humans
  • Glycated Hemoglobin