mHealth
Does a diabetes phone app lower blood sugar over a year?
Open access · cc by · source: Europe PMC
A year of using a diabetes self-management phone app, with or without a short course of nurse phone counselling, did not lower long-term blood sugar more than usual care.
Study at a glance
- Design
- RCT — 3-arm open-label RCT (1:1:1 block randomisation): app only, app plus 4 months of phone health counselling, or usual care; 1-year follow-up
- N
- N=151 · 151 randomised (51 app, 50 app plus counselling, 50 control); HbA1c available for 120 at 1 year
- Population
- Adults in Norway with type 2 diabetes and HbA1c at or above 7.1%, recruited mainly via general practitioners
- Outcome
- Primary: change in HbA1c at 1 year; secondary: self-management (heiQ), quality of life (SF-36), depressive symptoms (CES-D), weight, diet and physical activity
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Key findings
HbA1c fell in all three groups, but the change did not differ between either app group and usual care after 1 year. There were no between-group differences in weight, quality of life, depressive symptoms, diet or physical activity. The only positive secondary result was a small gain in the 'skill and technique acquisition' self-management domain in the app-plus-counselling group (B = 0.21). Only about a third of app users used it substantially, and, unexpectedly, participants aged 63 or over were more likely to be heavy users (OR 2.7).
Methodology
Adults with poorly controlled type 2 diabetes were randomised to usual care, a phone app linked by Bluetooth to a glucose meter (with diet, activity and goal-setting diaries), or the same app plus five monthly motivational-interviewing phone calls from a diabetes nurse during the first 4 months. Everyone kept seeing their GP as normal. Outcomes were measured at baseline, 4 months and 12 months, analysed by intention-to-treat and adjusted for age, gender and education.
Limitations
The trial was small and powered only for HbA1c, and 21% dropped out, so modest effects on secondary outcomes could be missed. Low use of the app, partly because the phones became outdated during the trial, means it tested offering the app rather than using it consistently. Participants could not be blinded, the control group happened to have more depressive symptoms at baseline, and volunteers motivated to join an mHealth study may not represent typical patients. The authors also question whether HbA1c is the right outcome for a self-management intervention.
How this study connects
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