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

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.

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.

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.

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 (HbA_1c) levels for the 12-months study period (P=.011). The HbA_1c 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 HbA_1c 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.

UUS as a measure of patient engagement was associated with changes in HbA_1c 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.

ClinicalTrial.gov NCT03033407; https://clinicaltrials.gov/ct2/show/NCT03033407.