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

Abstract

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 (HbA 1c ) 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 HbA 1c [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 HbA 1c (–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 (main...

TRIal to slow the Progression Of Diabetes (TRIPOD): study protocol for a randomized controlled trial using wireless technology and incentives

“…The 24-week GlycoLeap program consisted of a comprehensive T2DM educational curriculum delivered online and the Glyco smartphone app, through which users logged and monitored their blood glucose levels, weight, meals, and physical activity and received personal health coaching by accredited dietitians. Although we observed statistically significant improvements in HbA 1c (-1.3 percentage points, P<.001) and weight reduction (2.3% reduction from baseline weight, P<.001), the proportion of participants meeting recommended weekly self-care process targets declined throughout the 24-week period for all evaluated components, potentially attenuating the longer-term benefits of sustained lifestyle management [14]. To address this concern, we have developed a rewards program based on behavioral economic theory to complement GlycoLeap.…”

Current Developments in Digital Quantitative Volume Estimation for the Optimisation of Dietary Assessment

“…The earliest forms began with simple text-based platforms that allowed users to type in the names and quantities of consumed foods [53]. Improvements to online communication platforms and smartphones have allowed apps to evolve beyond just text-based systems to include integrating image-based dietary recording, health coaching and dietary consultation into the functionality of the apps [38,[62][63][64]. Further advances in computer vision and smartphone on-board processing capacity have also recently opened the door to image recognition and segmentation capabilities, indicating a potential for foods to be automatically identified and categorized as required for further processing [65].…”

“…Many of these apps have been well received by consumers and facilitate improvements to the predictors of behavior change such as knowledge, self-efficacy and motivation [37,60,[67][68][69][70][71][72]. Being able to be in contact with a healthcare professional also provides a layer of support whenever required, and this has been shown to improve engagement and satisfaction with the lifestyle change [38,58,60,62,63].…”

“…Using digital solutions also reduces the burden placed on respondents and healthcare professionals [53,60,67,73]. Many studies have found that users prefer the use of digital dietary recording over traditional paper methods for ergonomic and practical reasons [27,28,37,38,52,58,60,62,67,71,72,74]. Smart devices are highly integrated into modern lifestyles and are less intrusive to daily routines as users do not need to carry around an additional item such as a journal to record their diets with.…”

TRIal to slow the Progression Of Diabetes (TRIPOD): study protocol for a randomized controlled trial using wireless technology and incentives

“…In a previous feasibility study, we evaluated a proprietary lifestyle management program, GlycoLeap [designed and produced by KKT Technology Pte. Ltd. (Holmusk, Singapore)], which was originally developed for adults with T2DM in Singapore [14]. week GlycoLeap program consisted of a comprehensive T2DM educational curriculum delivered online and the Glyco smartphone app, through which users logged and monitored their blood glucose levels, weight, meals, and physical activity and received personal health coaching by accredited dietitians.…”