Background The System Usability Scale (SUS) is a common metric used to assess the usability of a system, and it was initially developed in English. The implementation of electronic systems for clinical counseling (eHealth and mobile health) is increasing worldwide. Therefore, tools are needed to evaluate these applications in the languages and regional contexts in which the electronic tools are developed. Objective This study aims to translate, culturally adapt, and validate the original English version of the SUS into a Spanish version. Methods The translation process included forward and backward translation. Forward translations were made by 2 native Spanish speakers who spoke English as their second language, and a backward translation was made by a native English speaker. The Spanish SUS questionnaire was validated by 10 experts in mobile app development. The face validity of the questionnaire was tested with 10 mobile phone users, and the reliability testing was conducted among 88 electronic application users. Results The content validity index of the new Spanish SUS was good, as indicated by a rating of 0.92 for the relevance of the items. The questionnaire was easy to understand, based on a face validity index of 0.94. The Cronbach α was .812 (95% CI 0.748-0.866; P<.001). Conclusions The new Spanish SUS questionnaire is a valid and reliable tool to assess the usability of electronic tools among Spanish-speaking users.

Background Lifestyle is the focus of type 2 diabetes (T2D) prevention strategies. Prevention strategies using mobile health (mHealth)–based therapy have shown positive results for T2D prevention in high-income settings, but little is known about their effectiveness in low- and middle-income populations where the burden of T2D is substantial. “Vida Sana” is a web platform designed to record lifestyle habits and medication use within a lifestyle change program. Objective We sought to identify the barriers, feasibility, usability, and effectiveness of Vida Sana to record lifestyle habits in subjects at risk of developing T2D in a middle-income setting. Methods This was a 3-month prospective interventional study in Mexican individuals. A total of 77 subjects at risk of T2D (with prediabetes and BMI between 24 and 40 kg/m2) were selected. Feasibility was assessed by study retention. Usability was evaluated with the System Usability Scale (SUS). Effectiveness measures included changes in weight, body composition, BMI, glycated hemoglobin A1c (HbA1c), and fasting blood glucose from baseline to 3 months. Linear regression models were used to account for covariates. Results The feasibility of Vida Sana was 42%, with 33 subjects using the platform, and the usability was 48.7 (SD 14.24). Reported barriers to platform usage were; difficulty in accessing the platform from difficulty of use (12 subjects, 36%), lack of time to record their habits (11 subjects, 34%), lack of interest to record their habits (6 subjects, 18%), and lack of resources (4 subjects, 11%). The platform was effective for lowering glucose in fasting (–3.1 mg/dL vs –0.11 [SD 8.08] mg/dL; P=.038) and at 2 hours (–16.9 mg/dL vs 2.5 [SD 26.1] mg/dL; P=.045), body fat percentage (–1.3 [–2.2 to –0.7] vs –1.02 [–1.9 to –0.3]; P=.02), and waist circumference (–3.2 [SD 5.1] cm vs –1.7 [SD 5.0] cm; P=.02) independent of their age, sex, treatment, and education level. Conclusions The use of the web platform was effective for improving glycemic and anthropometric parameters in a population at risk of developing diabetes. Improving accessibility and ease of navigation could improve the acceptance of digital health solutions in a middle-income population.

Objectives Lifestyle is the main focus of Type 2 diabetes (T2D) prevention strategies. mHealth-based therapy has proved positive results for T2D prevention in high-income settings, but little is known about its effectiveness in low- and middle-income populations where the burden of T2D is substantial. We sought to identify barriers, feasibility, usability, and effectiveness of an electronic platform “Vida Sana”, to record lifestyle habits in subjects at risk of developing type 2 diabetes in a middle-income setting. Methods This was a 3-month prospective interventional study of subjects at risk of T2D (prediabetes and body mass index (BMI) between 24 kg/m2 and 40 kg/m2.) Feasibility was assessed by study retention. Usability was evaluated with the System Usability Scale (SUS). Effectiveness measures included changes in weight, body composition, BMI, anthropometric measures, glycated hemoglobin (HbA1c), and fasting blood glucose from baseline to 3-month visit. Linear regression models were used to account for covariates. Results The feasibility of Vida Sana was 42.8% (n = 33 subjects), and the usability was 48.7% ± 14.2. The barriers reported for not using the platform were difficulty for access to the platform (36.3%), lack of time to record their habits (34.0%) lack of interest to record their habits (18.18%), and lack of resources (11.3%) (computer or internet). The platform was effective for lowering glucose in fasting (−3.1 mg/dL vs −0.11 ± 8.08; P = 0.038) and at 2 hr (−16.9 mg/dL vs 2.5 ± 26.1; P = 0.045), body fat % (−1.3 (−2.2 – −0.7) s −1.02 (−1.9 - −0.3); P = 0.024), and waist circumference (−3.2 ± 5.1 cm vs −1.7 ± 5.0; P = 0.023) independent their age, sex, treatment and education attainment. Conclusions The use of an electronic platform was effective to improve glycemic and anthropometric parameters in a population at risk of developing diabetes. Improving accessibility and ease of navigation could be objectives to improve the acceptance of mobile applications in a middle-income population. Funding Sources Miguel Aleman Medical Research Award.

Objectives A haplotype in SLC16A11 is associated with decreased insulin action, and risk for type 2 diabetes (T2D) in Mexicans. We aim to determine the impact of the risk haplotype on SLC16A11 on early therapeutic responses in treatments to prevent T2D. Methods We recruited subjects with at least one prediabetes criteria according to the American Diabetes Association, and body mass index 25–45 kg/m2. Subjects were randomized in two groups: lifestyle intervention (LSI): hypocaloric diet, 25 kcal/kg of ideal weight, 45% of the total intake of carbohydrates, 30% lipids and 15% protein sources + physical activity (&gt;150 min medium intensity per week), or LSI + metformin (750 mg prolonged release twice a day). Interventions were prescribed by standardized dietitians. The goal was to achieve &gt;3% weight loss. We evaluated the early treatment response in a follow-up period of 12 weeks with intermediate visits each 3 weeks to reinforce knowledge and treatment goals. Evaluations (baseline and post-treatment) included an oral glucose tolerance test (OGTT), and dual-energy X-ray absorptiometry. Adherence to treatment was measured trough electronic recordings. Participants were genotyped for the risk allele rs13342232. Researchers remained blinded to the genotype results. The effects of the risk haplotype were evaluated with linear and logistic regressions adjusted by age, sex, and baseline body fat %. Results We evaluated 61 subjects, 30 carriers, and 31 non-carriers. Most of participants (57%) achieved ≥3% weight loss. The LSI + metformin treatment increased in carriers, 2 times OR 3 IC95% (1.07 – 8.6) (P = 0.04) the probability to reach the ≥3% weight loss goal compared with LSI and non-carriers. In the same treatment, carriers had a greater decrease in the total and incremental area under the curve of insulin in the OGTT IC95% (−1.75 −0.11) (P = 0.02) compared with non-carriers and LSI. Carriers also had higher decrease in postprandial glucose compared with non-carriers regardless of treatment −12.63 + 30.38 vs 0.71 30.24 (P = 0.02). Conclusions After 12 weeks of treatment, carriers with prediabetes showed a higher probability achieve weight loss and to improve insulin secretion with metformin. Regardless of the treatment, carriers were prone to improve postprandial glucose. Funding Sources Miguel Aleman Medical Research Award.

BACKGROUND Lifestyle is the main focus of the Type 2 diabetes (T2D) prevention strategies. mHealth-based therapy has proved positive results for T2D prevention in high-income settings, but little is known about their effectiveness in low- and middle-income populations where the burden of T2D is substantial. OBJECTIVE We sought to identify barriers, feasibility, usability and effectiveness of an electronic platform “Visa Sana”, to record lifestyle habits in subjects at risk of developing type 2 diabetes in a middle-income setting. METHODS This was a 3-months prospective interventional study of subjects at risk of T2D (prediabetes and body mass index (BMI) between 24 kg/m2 and 40 kg/m2.) Feasibility was assessed by study retention. Usability was evaluated with the System Usability Scale (SUS). Effectiveness measures included changes in weight, body composition, BMI, glycated hemoglobin (HbA1c), and fasting blood glucose from baseline to 3-months visit. Lineal regression models were used to account for covariates. RESULTS The feasibility of Vida Sana was 42.8% (n=33 subjects), and the usability was 48.71% + 14.24. The barriers reported for not using the platform were difficulty for access to the platform (36.36%), lack of time to record their habits (34.09%) lack of interest to record their habits (18.18%), and lack of resources (11.36%) The platform was effective for lowering glucose in fasting (-3.18mg/dL vs -0.11+8.08; p = 0.038) and at 2hr (-16.97mg/dL vs 2.59 + 26.14; p = 0.045) , body fat percent (-1.36 (-2.23 – - 0.75) vs -1.02 (-1.92 - -0.31); p=0.024), and waist circumference (-3.92 + 5.13cm vs -1.73 + 5.01; p=0.023) independent their age, sex, treatment and education attainment. CONCLUSIONS The use of an electronic platform was effective to improve glycemic and anthropometric parameters in a population at risk of developing diabetes. Improving accessibility and ease of navigation could be objectives to improve the acceptance of mobile applications in a middle-income population.

BACKGROUND The mHealth concept encompasses the use of mobile devices for clinical counseling. The System Usability Scale (SUS) is a common metric used to assess the usability of a system. The SUS was initially developed in English, and it would need to be updated and adapted to languages and regional contexts in which the electronic tools are developed. OBJECTIVE The objective of this study is to translate, culturally, adapt, and validate the original English version of the SUS into a new Spanish version. METHODS The translation process included forward and backward translation, forward translations was made by two native Spanish speakers, who spoke English as their second language, and backward translation was made by an English native speaker. The Spanish SUS questionnaire was validated by 10 experts in mobile app development. The face validity of the questionnaire was tested on 10 mobile phone users, and finally, the reliability testing was probed in 88 electronic app users. RESULTS The content validity index of the new Spanish SUS was good based on the rating of the relevance of items of 0.92. The questionnaire was easy to understand based on the face validity index of 0.94. According to Cronbach’s alpha test 0.81 IC95% (0.74 – 0.86), the translated scale is s a reliable tool for the assessment of the usability of electronic tools. CONCLUSIONS The new Spanish SUS questionnaire is a valid and reliable tool to assess the usability of electronic tools for Spanish users,