Digital Discharge Planning to Improve Self-Management in Patients With Diabetes Mellitus (DDP-DM)

Effectiveness of a Digital Discharge Planning Intervention to Improve Self-Management in Patients With Diabetes Mellitus: A Randomized Controlled Trial

Diabetes mellitus is a chronic disease that requires continuous self-management to prevent complications and hospital readmissions. However, discharge planning in many hospitals is often delivered verbally and lacks structured follow-up after patients return home, which may lead to poor self-management behaviors.

This study aims to evaluate the effectiveness of a digital discharge planning intervention delivered through a mobile application to improve self-management among patients with diabetes mellitus after hospital discharge. The intervention is based on the Chronic Care Model and includes educational materials, reminders, and monitoring tools related to seven dimensions of diabetes self-management.

A randomized controlled trial with a parallel-group design will be conducted among patients with diabetes mellitus. Participants in the intervention group will receive digital discharge planning through a mobile application for 90 days after discharge, while the control group will receive standard discharge planning provided by the hospital. Primary outcomes include patient self-management behavior, while secondary outcomes include glycemic control and hospital readmission within 90 days.

Study Overview

• Status: Not yet recruiting
• Conditions: Diabetes (DM)
• Intervention / Treatment: Behavioral: Digital Discharge Planning Application; Behavioral: Standard Discharge Planning

Detailed Description

Diabetes mellitus is one of the most prevalent chronic diseases worldwide and requires long-term self-management to maintain glycemic control and prevent complications. Effective discharge planning plays an important role in preparing patients to manage their condition independently after leaving the hospital. However, in many clinical settings, discharge planning is often delivered verbally and without structured follow-up, which may limit patients' ability to maintain appropriate self-management behaviors.

This study develops and evaluates a digital discharge planning model delivered through a mobile application to support patients with diabetes mellitus after hospital discharge. The intervention is theoretically grounded in the Chronic Care Model and supported by nursing theories including Orem's Self-Care Deficit Theory, Watson's Human Caring Theory, and Pender's Health Promotion Model.

The mobile application includes several features designed to support diabetes self-management based on the Diabetes Canada framework, including healthy eating, physical activity, blood glucose monitoring, medication adherence, problem solving, reducing risks, and healthy coping. The application provides educational materials, reminders, daily activity tracking, and feedback to encourage patient engagement and adherence to self-management practices.

A randomized controlled trial with a parallel-group design will be conducted to evaluate the effectiveness of the intervention. Participants will be randomly assigned to either the intervention group receiving digital discharge planning through the mobile application or the control group receiving standard discharge planning provided by the hospital. The intervention period will last for 90 days following hospital discharge. The study will assess the impact of the digital discharge planning model on self-management behaviors, glycemic control, and hospital readmission among patients with diabetes mellitus.

• Study Type: Interventional
• Enrollment (Estimated): 78
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ririn Kartika Novitasari; Phone Number: +6285728040905; Email: j218240017@student.ums.ac.id

Study Locations

• Indonesia
  • Central Java
    • Sukoharjo, Central Java, Indonesia, 57557
      • RS Universitas Sebelas Maret
      • Contact: Ririn Novitasari; Phone Number: +6285728040905; Email: j218240017@student.ums.ac.id

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Patients diagnosed with diabetes mellitus.
• Age 18 years or older.
• Hospitalized patients who are preparing for discharge.
• Able to use a smartphone and access the mobile application.
• Willing to participate and provide informed consent.

Exclusion Criteria:

• Patients with severe complications requiring intensive care.
• Patients with cognitive impairment or severe mental illness that may interfere with participation.
• Patients who are unable to operate a smartphone or mobile application.
• Patients who decline to participate in the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Digital Discharge Planning; Participants receive digital discharge planning through a mobile application for 90 days after hospital discharge.	Behavioral: Digital Discharge Planning Application; A mobile health application designed to support diabetes self-management after hospital discharge, including education, reminders, and monitoring tools for 90 days.
Active Comparator: Standard Discharge Planning; Participants receive standard discharge planning routinely provided by the hospital.	Behavioral: Standard Discharge Planning; Participants receive standard discharge planning routinely provided by the hospital according to usual care procedures.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in diabetes self-management score	Diabetes self-management will be assessed using an adapted Indonesian version of the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire consisting of 21 items across seven domains (healthy eating, physical activity, blood glucose monitoring, medication adherence, problem solving, risk reduction, and healthy coping). Each item is scored on a 5-point Likert scale (1-5) reflecting frequency of behavior during the past 7 days. Total scores range from 21 to 105, with higher scores indicating better diabetes self-management behavior.	Baseline to 90 days after hospital discharge

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in HbA1c level	Glycemic control will be assessed by measuring glycated hemoglobin (HbA1c) levels before the intervention and at the end of the 90-day follow-up period.	Baseline to 90 days
Hospital readmission within 90 days	Hospital readmission due to diabetes-related complications within 90 days after discharge will be recorded from hospital records.	Within 90 days after hospital discharge

Collaborators and Investigators

• Sponsor: Universitas Muhammadiyah Surakarta

Study record dates

Study Major Dates

• Study Start (Estimated): April 15, 2026
• Primary Completion (Estimated): October 30, 2026
• Study Completion (Estimated): November 30, 2026

Study Registration Dates

• First Submitted: March 31, 2026
• First Submitted That Met QC Criteria: March 31, 2026
• First Posted (Actual): April 7, 2026

Study Record Updates

• Last Update Posted (Actual): April 13, 2026
• Last Update Submitted That Met QC Criteria: April 6, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Mobile Health; Digital Health Intervention; Discharge Planning; Diabetes Self-Management
• Additional Relevant MeSH Terms: Endocrine System Diseases; Metabolic Diseases; Glucose Metabolism Disorders; Nutritional and Metabolic Diseases; Diabetes Mellitus
• Other Study ID Numbers: DPD-DM-RCT-2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be publicly shared due to privacy and confidentiality considerations. Data may be available from the principal investigator upon reasonable request.

Drug and device information, study documents

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