@Article{info:doi/10.2196/mhealth.3882,
author="Holmen, Heidi
and Torbj{\o}rnsen, Astrid
and Wahl, Astrid Klopstad
and Jenum, Anne Karen
and Sm{\aa}stuen, Milada Cvancarova
and {\AA}rsand, Eirik
and Ribu, Lis",
title="A Mobile Health Intervention for Self-Management and Lifestyle Change for Persons With Type 2 Diabetes, Part 2: One-Year Results From the Norwegian Randomized Controlled Trial RENEWING HEALTH",
journal="JMIR mHealth uHealth",
year="2014",
month="Dec",
day="11",
volume="2",
number="4",
pages="e57",
keywords="self-care; mobile applications; cellular phone; telemedicine; counseling; motivational interviewing; diabetes mellitus, type 2; hemoglobin A1c protein, human",
abstract="Background: Self-management is crucial in the daily management of type 2 diabetes. It has been suggested that mHealth may be an important method for enhancing self-management when delivered in combination with health counseling. Objective: The objective of this study was to test whether the use of a mobile phone--based self-management system used for 1 year, with or without telephone health counseling by a diabetes specialist nurse for the first 4 months, could improve glycated hemoglobin A1c (HbA1c) level, self-management, and health-related quality of life compared with usual care. Methods: We conducted a 3-arm prospective randomized controlled trial involving 2 intervention groups and 1 control group. Eligible participants were persons with type 2 diabetes with an HbA1c level ≥7.1{\%} (≥54.1 mmol/mol) and aged ≥18 years. Both intervention groups received the mobile phone--based self-management system Few Touch Application (FTA). The FTA consisted of a blood glucose--measuring system with automatic wireless data transfer, diet manual, physical activity registration, and management of personal goals, all recorded and operated using a diabetes diary app on the mobile phone. In addition, one intervention group received health counseling based on behavior change theory and delivered by a diabetes specialist nurse for the first 4 months after randomization. All groups received usual care by their general practitioner. The primary outcome was HbA1c level. Secondary outcomes were self-management (heiQ), health-related quality of life (SF-36), depressive symptoms (CES-D), and lifestyle changes (dietary habits and physical activity). Data were analyzed using univariate methods (t test, ANOVA) and multivariate linear and logistic regression. Results: A total of 151 participants were randomized: 51 to the FTA group, 50 to the FTA-health counseling (FTA-HC) group, and 50 to the control group. Follow-up data after 1 year were available for 120 participants (79{\%}). HbA1c level decreased in all groups, but did not differ between groups after 1 year. The mean change in the heiQ domain skills and technique acquisition was significantly greater in the FTA-HC group after adjusting for age, gender, and education (P=.04). Other secondary outcomes did not differ between groups after 1 year. In the FTA group, 39{\%} were substantial users of the app; 34{\%} of the FTA-HC group were substantial users. Those aged ≥63 years used the app more than their younger counterparts did (OR 2.7; 95{\%} CI 1.02-7.12; P=.045). Conclusions: The change in HbA1c level did not differ between groups after the 1-year intervention. Secondary outcomes did not differ between groups except for an increase in the self-management domain of skill and technique acquisition in the FTA-HC group. Older participants used the app more than the younger participants did. ",
issn="2291-5222",
doi="10.2196/mhealth.3882",
url="http://mhealth.jmir.org/2014/4/e57/",
url="https://doi.org/10.2196/mhealth.3882",
url="http://www.ncbi.nlm.nih.gov/pubmed/25499872"
}