Dietary Intake and Health Status of Elderly Patients With Type 2 Diabetes Mellitus: Cross-sectional Study Using a Mobile App in Primary Care (Preprint)

Abstract

BACKGROUND Healthy dietary intake reduces the risk of complications of diabetes mellitus. Using assessment methods helps to understand these circumstances, and an electronic application may optimize this practice. OBJECTIVE In this study, we aim to (1) assess the dietary intake and health status of elderly patients with T2DM from primary care; (2) use a mobile app as a tool for data collection and analysis in the context of primary care; and (3) verify the perceptions of multidisciplinary health professionals regarding the app use. METHODS First, we developed a mobile app comprising the questions of the Food and Nutrition Surveillance System (SISVAN) of Brazil, which includes a food frequency questionnaire of food categories with a recall of the previous 7 days. Thereafter, we used the app to collect data on the health status and dietary intake of 154 participants, aged 60-96 years, diagnosed with type 2 diabetes and under treatment in primary care centers in the northern region of Rio Grande do Sul, Brazil. We also collected participants’ demographic, anthropometric, biochemical, and lifestyle variables. The associations between the dietary intake and other variables were tested using the Chi-square test with a 5% significance level. Regarding the app, we assessed usability and acceptance with 20 health professionals. RESULTS Between August and December 2018, participants had an intake in line with recommended guidelines for raw salads (57.1%), fruits (76.6%), milk products (68.2%), fried foods (72.7%), savory biscuits (60.4%), cookies or sweets (72.1%), and sugary drinks (92.9%) Meanwhile, the consumption not in line with the guidelines was for beans (59.7%), pulses and cooked vegetables (73.4%), and processed meat products (59.7%). There were statistically significant differences in meeting the recommended guidelines among participants of different genders (P=.006 and P=.035 for the intake of fried foods and sugary drinks, respectively), place of residence (P=.034 for the intake of cookies and sweets), family history of diabetes (P<.001 for the intake of beans), physical activity engagement (P=.003 for the intake fresh fruits), history of smoking (P=.001 for the intake of raw salads), and presence of coronary diseases (P=.050 for the intake of pulses and cooked vegetables). The assessment of usability resulted in a mean score of 71.75 points. Similarly, the assessment of the 15 acceptance questions revealed high scores and the qualitative questions revealed positive perceptions. CONCLUSIONS We found that most participants comply with recommended intake guidelines for 7 out of 10 categories of SISVAN guidelines. However, most participants were overweight and had nutritional and clinical disorders, which justifies further investigations in this population. The app was well-rated by health professionals and considered a useful and promising tool in collecting and analyzing data in primary care settings. CLINICALTRIAL