In a recent study published in BMC Medicine, a team of South Korean researchers evaluated whether a smartphone application (app) for maintaining personal health records encouraged physical activity, improved step counts and glycemic control, and controlled body weight in patients with type 2 diabetes.

Study: A randomized controlled trial of an app-based intervention on physical activity and glycemic control in people with type 2 diabetes. Image Credit: insta_photos/Shutterstock.com

Background

Diabetes is a rapidly growing global health concern, with a current incidence rate of approximately 10.5%, which is expected to increase substantially in the next two decades.

The health burden imposed by diabetes is also expected to increase considerably in the next 20 years, especially due to the cardiovascular complications that result from the disease.

Exercise and adequate physical activity have been consistently recommended as one of the most effective ways to manage diabetes and other metabolic disorders such as obesity.

According to the American Diabetes Association, diabetes patients should perform aerobic activity of moderate intensity for a minimum of 150 minutes a day for three to seven days every week.

Other studies have found that walking between 8,000 and 10,000 steps a week equals 23 metabolic equivalents of tasks (MET) hours.

However, while studies have reported the beneficial effects of regular exercise in improving blood glucose and insulin resistance, the direct association between step count interventions and glycemic and body weight control in diabetes patients has not been well explored.

About the study

In the present study, the researchers examined whether monitoring step counts using a smartphone-based personal health record app and encouragement provided through text messages to increase physical activity had a positive impact on step counts and glycemic and body weight control over a total period of 24 weeks in patients with type 2 diabetes.

The study included participants between 20 and 69, with glycated hemoglobin or HbA1c lower than 8.5%, and had not required any anti-diabetic medication in the previous four weeks.

The included participants had a body mass index (BMI) greater than or equal to 23 kg per m², which is categorized as overweight or obese and had required one or more doses of an oral hypoglycemic agent in the preceding 12 weeks.

Individuals who had other forms of diabetes, such as gestational or type 1 diabetes, were using glucagon-like peptide one agonists or insulin, or had other comorbidities such as acute kidney injury, chronic liver disease, drug or alcohol addiction, or were on medications or agents to lower weight were excluded.

The study was conducted over three periods — the run-in period lasting one week and randomized treatment and extension periods of 12 weeks each.

The participants were provided with a smartphone personal health record app developed by the Samsung Medical Center that recorded blood pressure, blood glucose, and body weight.

Step counts were also recorded in the app. Patients were randomly assigned to the intervention and control groups. Text message encouragements to improve step count over the 12 weeks were sent only to the participants in the intervention group.

The primary outcome examined in this study was the improvement in step count between the control and intervention groups.

The secondary outcomes included changes in HbA1c, fasting glucose levels, physical activity levels, body weight, and a range of lipid levels such as total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein.

Results

The results showed that motivational interventions through smartphone apps did not significantly improve the daily step count over 12 weeks in individuals with type 2 diabetes, and the changes in HbA1c levels were comparable between the control and intervention groups.

However, among individuals with less than 7,500 mean daily steps at baseline, the improvement in daily step count at the end of 12 weeks was significantly greater than the change observed for the participants in the control group.

The researchers believe the lack of significant improvements in the other groups could be due to decreasing motivation.

Furthermore, among individuals who had baseline mean step count measures of over 7,500 steps, increasing the step count could have been more challenging than for individuals who walked less than 7,500 steps at baseline.

Additionally, while the changes in body weight were found to be significant in the intervention group between weeks 12 and 24, no significant difference was observed for body weight changes between intervention and control groups, indicating that encouraging text messages did not have a notable impact on the physical activity levels of the participants.

Conclusions

Overall, the findings indicated that smartphone-based applications that monitor personal health records have the same impact in improving physical activity levels or step counts in type 2 diabetes patients, with or without encouraging text messages.