title: Short-term trajectories of use of a caloric-monitoring mobile phone app among patients with type 2 diabetes mellitus in a primary care setting.
abstract: 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.
authors: Duke-NUS Graduate Medical School, Singapore, Singapore.
authors: Glenn
authors: http://orcid.org/0000-0003-0357-239X
authors: G
authors: Goh
authors: Ngiap Chuan
authors: http://orcid.org/0000-0002-5946-1149
authors: NC
authors: Tan
authors: Rahul
authors: http://orcid.org/0000-0002-9978-4276
authors: R
authors: Malhotra
authors: Uma
authors: http://orcid.org/0000-0003-3099-5195
authors: U
authors: Padmanabhan
authors: Sylvaine
authors: http://orcid.org/0000-0002-8249-3755
authors: S
authors: Barbier
authors: John Carson
authors: http://orcid.org/0000-0003-4570-109X
authors: JC
authors: Allen
authors: Truls
authors: http://orcid.org/0000-0002-0662-7440
authors: T
authors: Østbye
mesh_terms: D040421:Cell Phone / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications / Q000706:statistics & numerical data*; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D011320:Primary Health Care / Q000379:methods; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods
chemical_list: D006442:Glycated Hemoglobin
keywords: longitudinal studies; mobile apps; mobile phone; self-management; type 2 diabetes mellitus
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