title: A Mobile Health Intervention for Self-Management and Lifestyle Change for Persons With Type 2 Diabetes, Part 2: One-Year Results From the Norwegian Randomized Controlled Trial RENEWING HEALTH.
abstract: BACKGROUND
  Self-management is crucial in the daily management of type 2 diabetes. It has been suggested that mHealth may be an important method for enhancing self-management when delivered in combination with health counseling.
  
  
  OBJECTIVE
  The objective of this study was to test whether the use of a mobile phone-based self-management system used for 1 year, with or without telephone health counseling by a diabetes specialist nurse for the first 4 months, could improve glycated hemoglobin A1c (HbA1c) level, self-management, and health-related quality of life compared with usual care.
  
  
  METHODS
  We conducted a 3-arm prospective randomized controlled trial involving 2 intervention groups and 1 control group. Eligible participants were persons with type 2 diabetes with an HbA1c level ≥7.1% (≥54.1 mmol/mol) and aged ≥18 years. Both intervention groups received the mobile phone-based self-management system Few Touch Application (FTA). The FTA consisted of a blood glucose-measuring system with automatic wireless data transfer, diet manual, physical activity registration, and management of personal goals, all recorded and operated using a diabetes diary app on the mobile phone. In addition, one intervention group received health counseling based on behavior change theory and delivered by a diabetes specialist nurse for the first 4 months after randomization. All groups received usual care by their general practitioner. The primary outcome was HbA1c level. Secondary outcomes were self-management (heiQ), health-related quality of life (SF-36), depressive symptoms (CES-D), and lifestyle changes (dietary habits and physical activity). Data were analyzed using univariate methods (t test, ANOVA) and multivariate linear and logistic regression.
  
  
  RESULTS
  A total of 151 participants were randomized: 51 to the FTA group, 50 to the FTA-health counseling (FTA-HC) group, and 50 to the control group. Follow-up data after 1 year were available for 120 participants (79%). HbA1c level decreased in all groups, but did not differ between groups after 1 year. The mean change in the heiQ domain skills and technique acquisition was significantly greater in the FTA-HC group after adjusting for age, gender, and education (P=.04). Other secondary outcomes did not differ between groups after 1 year. In the FTA group, 39% were substantial users of the app; 34% of the FTA-HC group were substantial users. Those aged ≥63 years used the app more than their younger counterparts did (OR 2.7; 95% CI 1.02-7.12; P=.045).
  
  
  CONCLUSIONS
  The change in HbA1c level did not differ between groups after the 1-year intervention. Secondary outcomes did not differ between groups except for an increase in the self-management domain of skill and technique acquisition in the FTA-HC group. Older participants used the app more than the younger participants did.
authors.affiliation: Department of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway. Heidi.Holmen@hioa.no.
authors.forename: Heidi
authors.identifier: http://orcid.org/0000-0003-1314-7813
authors.initials: H
authors.lastname: Holmen
authors.forename: Astrid
authors.identifier: http://orcid.org/0000-0003-2385-2452
authors.initials: A
authors.lastname: Torbjørnsen
authors.forename: Astrid Klopstad
authors.identifier: http://orcid.org/0000-0002-5545-5710
authors.initials: AK
authors.lastname: Wahl
authors.forename: Anne Karen
authors.identifier: http://orcid.org/0000-0003-0304-7800
authors.initials: AK
authors.lastname: Jenum
authors.forename: Milada Cvancarova
authors.identifier: http://orcid.org/0000-0001-8947-8649
authors.initials: MC
authors.lastname: Småstuen
authors.forename: Eirik
authors.identifier: http://orcid.org/0000-0002-9520-1408
authors.initials: E
authors.lastname: Arsand
authors.forename: Lis
authors.identifier: http://orcid.org/0000-0003-1850-7902
authors.initials: L
authors.lastname: Ribu
keywords: cellular phone; counseling; diabetes mellitus, type 2; hemoglobin A1c protein, human; mobile applications; motivational interviewing; self-care; telemedicine