Outcomes-Based Health Program for Type 2 Diabetes

Outcomes-Based Health Program for Improving Care and Outcomes in Patients With Type 2 Diabetes: A Real-World Implementation Study in Primary Care

Type 2 diabetes is a growing health concern worldwide, influenced by genetic factors, overweight, metabolic syndrome, and insufficient physical activity. Good treatment and glycemic control can reduce or delay diabetes-related complications, which account for a significant and increasing share of healthcare costs in Finland. Much of this cost growth is due to complications resulting from inadequate diabetes care. Secondary prevention programs can therefore provide both health and economic benefits. Lifestyle interventions are one way to improve type 2 diabetes care and reduce complications.

This study aims to evaluate the impact of a digital lifestyle intervention combined with optimized care on treatment and outcomes among adults with type 2 diabetes at high risk for complications.

The intervention includes access to the BitHabit "Small Actions" application, which supports healthy lifestyle changes, and for participants with a body mass index (BMI) over 30, the Onnikka weight management application. The study will be conducted in North Savo, Finland, using a case-control design. Approximately 120 participants will receive the intervention and 50-100 will serve as controls. All participants will have their care plans reviewed and updated according to the Finnish Current Care Guidelines for Type 2 Diabetes. Control group participants will receive standard care, while the intervention group will receive standard care plus the digital tools. The study also includes the validation of the PAID (Problem Areas in Diabetes) questionnaire for use in Finland and in the Finnish language.

The study duration for each participant is 12 months. Data will be collected through physiological measurements, laboratory tests, questionnaires, and app usage logs. Measurements and questionnaires will be conducted at baseline and after 12 months. The analyses will describe the phenomenon, its prevalence, and associations between variables, as well as potential dependencies.

Study Overview

• Status: Recruiting
• Conditions: Type 2 Diabetes
• Intervention / Treatment: Other: BitHabit digital application for behavioral lifestyle changes; Other: Onnikka weight management digital application

• Study Type: Interventional
• Enrollment (Estimated): 200
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Elina Pimiä, MD; Phone Number: +358503222755; Email: elina.pimia@diabetes.fi
• Study Contact Backup: Name: Sonja Soininen, MD, PhD; Phone Number: +358444611199; Email: sonja.soininen@pshyvinvointialue.fi

Study Locations

• Finland
  • Northern Savonia
    • Kuopio, Northern Savonia, Finland
      • Recruiting
      • Wellbeing services county of North Savo, Nursing and Physician Services
      • Contact: Sonja Soininen, MD, PhD; Phone Number: +358444611199; Email: sonja.soininen@pshyvinvointialue.fi
      • Principal Investigator: Sonja Soininen, MD, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Type 2 diabetes diagnosed

• At least one of the following:

  1. diagnosed coronary artery disease,
  2. diagnosed periferal artery disease,
  3. diagnosed heart failure,
  4. diagnosed diabetic renal disease (GFR <60 OR uACR ≥ 3 for at least three months),
  5. diagnosed diabetic retinopathy,
  6. previous stroke,
  7. diagnosed atrial fibrillation or atrial flutter,

  8. age ≥ 55 years and at least two of the following conditions:

     1. smoker
     2. uses antihypertensive medication or systolic blood pressure >140 mmHg or diastolic blood pressure > 80 mmHg,
     3. uses lipid lowering medication or LDL-cholesterol > 2.6 or
     4. BMI > 25

Exclusion Criteria:

• eGFR < 30
• uACR > 200
• BMI > 50
• heart ejection fraction EF < 30
• active cancer or less than five years from cancer treatment at enrollment
• blindness in both eyes
• severe psychotic depression
• inability to utilize digital applications

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Digital intervention arm; Digital interventions: BitHabit application and optionally Onnikka application	Other: BitHabit digital application for behavioral lifestyle changes; BitHabit digital application for behavioral lifestyle changes; Other: Onnikka weight management digital application; Onnikka weight management digital application
No Intervention: Control group; Control group receives same enhancement in treatment plan, but no digital interventions

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline in weight at 12 months	Change from baseline in weight at 12 months. Weight measurement is taken by study nurse both at baseline and at the end of the study.	From enrollment to the end of follow-up at 12 months
Change from baseline in BMI at 12 months	Change from baseline in BMI at 12 months. Weight and height measurement are taken by study nurse both at baseline and at the end of the study.	From enrollment to the end of follow-up at 12 months
Change from baseline in waist circumference at 12 months	Change from baseline in waist circumference at 12 months. Waist circumference is taken by study nurse both at baseline and at the end of the study.	From enrollment to the end of follow-up at 12 months
Change from baseline in Body Roundness Index at 12 months	Change from baseline in Body Roundness Index at 12 months. Weight, height, waist and hip circumference are taken by study nurse both at baseline and at the end of the study.	From enrollment to the end of follow-up at 12 months
Change from baseline in HbA1c at 12 months	Change from baseline in HbA1c at 12 months. HbA1c is a laboratory measurement describing glucose levels, taken both at baseline and at the end of the study.	From enrollment to the end of follow-up at 12 months
Change from baseline in serum lipid levels at 12 months	Change from baseline in serum lipid levels at 12 months. LDL, HDL and triglycerides are laboratory measurements taken both at baseline and at the end of the study.	From enrollment to the end of follow-up at 12 months
Change from baseline in smoking status at 12 months	Change from baseline in smoking status at 12 months. Smoking status is surveyed both at baseline and at the end of the study.	From enrollment to the end of follow-up at 12 months
Change from baseline in physical activity at 12 months	Change from baseline in physical activity at 12 months. Physical activity is surveyed both at baseline and at the end of the study.	From enrollment to the end of follow-up at 12 months
Change from baseline in dietary habits at 12 months	Change from baseline in dietary habits at 12 months. Dietary habits are surveyed both at baseline and at the end of the study.	From enrollment to the end of follow-up at 12 months
Change from baseline in blood pressure at 12 months	Change from baseline in blood pressure at 12 months. Blood pressure measurement is taken by study nurse via Riva Rocci method both at baseline and at the end of the study.	From enrollment to the end of follow-up at 12 months
Self-reported changes from baseline in qualty of life measured by EQ-5D-5L at 12 months	EQ-5D-5L is a standard health questionnaire assessing quality of life across five dimensios: mobility, self-care, usual activities, pain/discomfort, anxiety/depression. EQ-5D-5L questionnaire is filled electronically at baseline and at the end of the study.	From enrollment to the end of follow-up at 12 months
Change from baseline in Problem Areas in Diabetes (PAID) scale at 12 months	PAID scale identifies emotional distress in diabetes, covering issues like worrying complications, goal setting, food, treatment, and social support, common problems including fear, anger, feeling overwhelmed and guilt.	From enrollment to the end of follow-up at 12 months

Collaborators and Investigators

• Sponsor: Kuopio University Hospital
• Collaborators: University of Eastern Finland; Finnish Diabetes Association
• Investigators: Principal Investigator: Sonja Soininen, MD, PhD, Wellbeing Services County of North Savo, Kuopio, Finland

Study record dates

Study Major Dates

• Study Start (Actual): April 10, 2025
• Primary Completion (Estimated): December 1, 2027
• Study Completion (Estimated): December 1, 2027

Study Registration Dates

• First Submitted: December 22, 2025
• First Submitted That Met QC Criteria: December 22, 2025
• First Posted (Actual): January 7, 2026

Study Record Updates

• Last Update Posted (Actual): January 7, 2026
• Last Update Submitted That Met QC Criteria: December 22, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Type 2 diabetes; PROM; High-risk type 2 diabetes patients; Digital lifestyle intervention; PAID
• Additional Relevant MeSH Terms: Endocrine System Diseases; Metabolic Diseases; Glucose Metabolism Disorders; Diabetes Mellitus; Nutritional and Metabolic Diseases; Diabetes Mellitus, Type 2
• Other Study ID Numbers: 5103906

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Study permission does not allow sharing individual participant data.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No