Short-term trajectories of use of a caloric-monitoring mobile phone app among patients with type 2 diabetes mellitus in a primary care setting

Background: self-management plays an important role in maintaining good control of diabetes mellitus,and mobile phone interventions have been shown to improve such self-management. the health promotion board of singapore has created a caloric-monitoring mobile health app,the interactive diet and activity tracker (idat). objective: the objective was to identify and describe short-term (8-week) trajectories of use of the idat app among patients with type 2 diabetes mellitus in a primary care setting in singapore,and identify patient characteristics associated with each trajectory. methods: a total of 84 patients with type 2 diabetes mellitus from a public primary care clinic in singapore who had not previously used the idat app were enrolled. the app was demonstrated and patients' weekly use of the app was monitored over 8 weeks. weekly use was defined as any record in terms of food entry or exercise workout entry in that week. information on demographics,diet and exercise motivation,diabetes self-efficacy (diabetes empowerment scale-short form),and clinical variables (body mass index,blood pressure,and glycosylated hemoglobin/hba1c) were collected at baseline. idat app use trajectories were delineated using latent-class growth modeling (lcgm). association of patient characteristics with the trajectories was ascertained using logistic regression analysis. results: three idat app use trajectories were observed: minimal users (66 out of 84 patients,78.6%,with either no idat use at all or use only in the first 2 weeks),intermittent-waning users (10 out of 84 patients,11.9%,with occasional weekly use mainly in the first 4 weeks),and consistent users (8 out of 84 patients,9.5%,with weekly use throughout all or most of the 8 weeks). the adjusted odds ratio of being a consistent user,relative to a minimal user,was significantly higher for females (or 19.55,95% ci 1.78-215.42) and for those with higher exercise motivation scores at baseline (or 4.89,95% ci 1.80-13.28). the adjusted odds ratio of being an intermittent-waning user relative to a minimal user was also significantly higher for those with higher exercise motivation scores at baseline (or 1.82,95% ci 1.00-3.32). conclusions: this study provides insight into the nature and extent of usage of a caloric-monitoring app among patients with type 2 diabetes and managed in primary care. the application of lcgm provides a useful framework for evaluating future app use in other patient populations. ©glenn goh,ngiap chuan tan,rahul malhotra,uma padmanabhan,sylvaine barbier,john carson allen jr,truls østbye.