A Novel User Utility Score for Diabetes Management Using Tailored Mobile Coaching: Secondary Analysis of a Randomized Controlled Trial

Min-Kyung Lee, Da Young Lee, Hong-Yup Ahn, Cheol-Young Park, Min-Kyung Lee, Da Young Lee, Hong-Yup Ahn, Cheol-Young Park

Abstract

Background: Mobile health applications have been developed to support diabetes self-management, but their effectiveness could depend on patient engagement. Therefore, patient engagement must be examined through multifactorial tailored behavioral interventions from an individual perspective.

Objective: This study aims to evaluate the usefulness of a novel user utility score (UUS) as a tool to measure patient engagement by using a mobile health application for diabetes management.

Methods: We conducted a subanalysis of results from a 12-month randomized controlled trial of a tailored mobile coaching (TMC) system among insurance policyholders with type 2 diabetes. UUS was calculated as the sum of the scores for 4 major core components (range 0-8): frequency of self-monitoring blood glucose testing, dietary and exercise records, and message reading rate. We explored the association between UUS for the first 3 months and glycemic control over 12 months. In addition, we investigated the relationship of UUS with blood pressure, lipid profile, and self-report scales assessing diabetes self-management.

Results: We divided 72 participants into 2 groups based on UUS for the first 3 months: UUS:0-4 (n=38) and UUS:5-8 (n=34). There was a significant between-group difference in glycated hemoglobin test (HbA1c) levels for the 12-months study period (P=.011). The HbA1c decrement at 12 months in the UUS:5-8 group was greater than that of the UUS:0-4 group [-0.92 (SD 1.24%) vs -0.33 (SD 0.80%); P=.049]. After adjusting for confounding factors, UUS was significantly associated with changes in HbA1c at 3, 6, and 12 months; the regression coefficients were -0.113 (SD 0.040; P=.006), -0.143 (SD 0.045; P=.002), and -0.136 (SD 0.052; P=.011), respectively. Change differences in other health outcomes between the 2 groups were not observed throughout a 12-month follow-up.

Conclusions: UUS as a measure of patient engagement was associated with changes in HbA1c over the study period of the TMC system and could be used to predict improved glycemic control in diabetes self-management through mobile health interventions.

Trial registration: ClinicalTrial.gov NCT03033407; https://ichgcp.net/clinical-trials-registry/NCT03033407.

Keywords: diabetes management; mobile applications; patient engagement; type 2 diabetes.

Conflict of interest statement

Conflicts of Interest: None declared.

©Min-Kyung Lee, Da Young Lee, Hong-Yup Ahn, Cheol-Young Park. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 24.02.2021.

Figures

Figure 1
Figure 1
Glycated hemoglobin (HbA1c) levels for the 12-month study period in the UUS:0-4 group and UUS:5-8 group. Repeated-measures ANOVA revealed significant differences between the groups over 12 months (P=.011). The last observation carried forward (LOCF) imputation method was used. UUS: user utility score.

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