Personalized Digital Health Solutions to Increasing Diabetes-Related Knowledge and Behavioral Outcomes: Results From a Randomized Controlled Trial.

Abstract

Background: The prevalence of diabetes in the United States necessitates investigations into how to better enable adults with type 2 diabetes mellitus (T2DM) to manage their health using easy-to-access and personally adaptable technologies. The ubiquity of digital content further justifies the need to consider the impact of different digital intervention modalities in diabetes self-care activities.

Objective: This study aimed to compare the impact of 2 digital diabetes self-care education programs delivered separately and in combination to adults with T2DM across various settings in Texas.

Methods: We conducted a randomized controlled trial in Texas with 188 adults with T2DM to assess whether 2 different interventions alone (Virtual Making Moves with Diabetes or Technology-Based Education and Support) or in combination (Virtual Making Moves with Diabetes followed by Technology-Based Education and Support) improved multiple outcomes associated with diabetes self-management. We used several estimation techniques, including generalized estimating equations, to account for multiple factors simultaneously.

Results: All 3 digital intervention modalities led to statistically significant improvements in diabetes-related confidence, distress, and self-care behaviors, with significance from baseline through 6 months and supported by moderate to strong effect sizes (Cohen d) ranging from 0.446 to 0.827 at 3-month follow-up versus baseline and from 0.538 to 0.888 at 6-month follow-up versus baseline. No statistically significant superiority was observed among the intervention modalities. Higher self-care behaviors were significantly associated with higher baseline confidence and lower distress. Those in the most disadvantaged positions (less education, less financial stability, and no health insurance) showed significantly larger improvement in self-care behaviors.

Conclusions: Given the benefits associated with this study's interventions, we suggest future work to further develop digital content that can be tailored to individuals with T2DM to help them manage their chronic conditions in a cost-effective manner.