Impact of a primary care-based mobile health intervention to ‘sit less and move more’ on glycemic control, HbA1c and cardiovascular risk factors in office employees with type 2 diabetes: A randomized controlled trial (Preprint)

Abstract

BACKGROUND Type 2 diabetes (DM2) is a highly prevalent, fatal and costly disease. Sedentary behaviour and physical inactivity are two of the main modifiable factors that contribute to its development. The use of mobile health (mHealth) applications in clinical practice implies new strategies in the control and management of DM2. However, the effect of their use on clinical variables, sedentary behaviour, physical inactivity and cardiovascular risk factors is not clear. OBJECTIVE This study evaluated the efficacy of an mhealth programme to “sit less and move more” at work –prescribed from clinical practice– on clinical variables and cardiovascular risk factors in office staff with DM2. METHODS A randomized controlled trial compared usual care (n=50) with an mhealth programme to sit less and move more. The intervention group (n=49), in addition to standard care, received an automated mobile phone Walk@Work-Application (W@W-App) and web-based intervention for 13 weeks that focused on decreasing and breaking up prolonged occupational sitting time in desk-based office employees. They were recruited in five primary health care centres (April 2019 to January 2020) in the metropolitan area of Barcelona (Spain). The main variables included glycemic control, HbA1c concentration, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides, which were measured by blood tests before the intervention and at 6- and 12-month follow-ups. The systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), physical activity level and sedentary behaviour (ActivPal device, Workforce Sitting Questionnaire) were measured before and after the intervention and at 6- and 12-month follow-ups. The results obtained from both groups were compared using a t-test for continuous variables and a chi-square test for qualitative variables. RESULTS In comparison with the control group, the participants in the intervention group had significant and clinically relevant reduction rates for glycated hemoglobin (HbA1c; ≤-0.5%), glycemia (p < 0.01), triglyceride levels (p < 0.01), SBP and DBP (p < 0.01) at the 12-month follow-up. There were also reductions in sitting time while at work at the 6- (p <0.01) and 12-month follow-ups (p<0.05) and in sitting time outside working hours on workdays doing leisure activities at the 6- and 12-month follow-ups (p<0.05). CONCLUSIONS An mhealth programme focused on decreasing and breaking up prolonged occupational sitting time in desk-based office employees was effective in the control of clinical variables and cardiovascular risk factors in adults with DM2. These types of programmes can be used as an affordable complementary method to facilitate positive health behaviour changes and prevent and control cardiovascular diseases in adults with DM2 from clinical practice. CLINICALTRIAL ClinicalTrials.gov NCT04092738. https://clinicaltrials.gov/ct2/show/NCT04092738 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s12889-022-13676-x