Association of a Health Belief Model-Based Digital Health Intervention with Glycolipid Metabolism and Health Behaviors in Older Adults with Type 2 Diabetes: A Quasi-Experimental Before-After Study.

Abstract

Purpose: Integrated management of blood glucose and lipids reduces complications in type 2 diabetes mellitus (T2DM). However, few community-based programs combine mobile health (mHealth) technology, Health Belief Model (HBM)-based education, behavioral strategies, and family support within one framework, and evidence in Chinese community settings is limited. We examined whether a 12-month HBM-based intervention was associated with changes in glycolipid metabolism and health behaviors among community-dwelling older adults with T2DM in Tianjin, China.

Patients and methods: This quasi-experimental, single-arm, uncontrolled before-after (pre-post) study included 114 T2DM patients (mean age 72.25 ± 5.63 years) managed at a community health service center; no parallel control group was enrolled. Paired samples t-tests and McNemar tests assessed changes in metabolic parameters and categorical health behaviors, respectively.

Results: All glucose and lipid parameters improved (all P < 0.0001). The primary outcomes changed as follows: HbA1c -0.63% points (95% CI -0.80 to -0.46), 2-hour postprandial glucose -5.16 mmol/L (95% CI -5.54 to -4.78), and triglycerides -2.61 mmol/L (95% CI -2.82 to -2.40). Fasting plasma glucose, total cholesterol, and LDL-cholesterol also decreased (Tables 3 and 4). Medication adherence rose from 73.68% to 86.84% (P = 0.013), disease knowledge from 50.88% to 76.32%, and regular exercise from 28.95% to 61.40% (both P < 0.0001); smoking and alcohol use were unchanged.

Conclusion: The HBM-based digital health intervention was associated with improved glycolipid metabolism and health behaviors in this cohort. Because the single-arm design lacked a control group and concurrent changes in glucose- and lipid-lowering medications were not recorded, all metabolic improvements - and the large triglyceride reduction in particular - may partly reflect pharmacological intensification; randomized controlled trials are needed to confirm these findings.