A Pilot Study on the Diameter app: Lifestyle Support for Type 2 Diabetes Mellitus Patients

Background: Diabetes mellitus is one of the most common non-communicable diseases worldwide. In patients with Diabetes Mellitus type 2 (T2DM), a healthy lifestyle is essential as it has positive effects on glucose regulation and therefore reduces the risk of complications. ZiekenhuisGroep Twente (ZGT), University of Twente (UT) and Roessingh Research & Development (RRD) developed ‘the Diameter’ in close corporation with T2DM patients and professionals from the outset. The Diameter is a mobile application that supports patients with T2DM to develop a healthy lifestyle to support optimal glucose regulation. The Diameter enables continuous monitoring of nutrition (via a food diary), physical activity (via activity tracker Fitbit) and glucose values (via Freestyle libre sensor). Furthermore, the Diameter offers guided goal setting, personal lifestyle coaching via daily informative and motivating coaching messages and weekly exercises aimed at learning to cope with barriers that arise in daily life to maintain a healthy lifestyle.
Methods: A mixed-method approach was used to explore intervention usage and acceptability regarding the Diameter. Ten patients with T2DM who were treated at the diabetes outpatient clinic of ZGT hospital used the Diameter for 10 weeks. Study participants monitored physical activity, nutrition, blood glucose values and the achievement of lifestyle goals. In addition, participants received digital coaching offered by two short coaching messages per day and one exercise per week. Log-data was analyzed to assess the number of times and duration the Diameter and each component was used. To assess acceptability, questionnaires and open-ended interviews were used to gain insight into perceptions of participants regarding the determinants of the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model and perceived barriers and facilitating conditions concerning Diameter usage.
Findings: The first results revealed that participants appreciated the self-monitoring functionalities the most as it provided new insights into lifestyle and how glucose levels respond accordingly. This resulted in the monitoring functions being used frequently over the entire period of use. About 80% of the coaching message was liked. Feedback included that messages often contained already known knowledge, but also provided useful advice to improve lifestyle. The purpose of the weekly exercises was unclear for some participants and this functionality was hardly used by them. About 85% of the exercises were completed by participants who understood the purpose of the exercise. Points for improvement can mainly be found in expanding the food diary with additional nourishments and offering more tailored coaching based on real-time data. According to the participants, the Diameter can lead to more personalized care by providing healthcare professionals with insight into lifestyle data and might have the potential to improve diabetes management if used in blended-care setting.
Discussion: The first perceptions regarding the Diameter were predominantly positive, although mainly the coaching components contain points for improvement. Clear information about the purpose of functionalities seems important to stimulate their use. Moreover, good integration of the Diameter in current diabetes care is considered an important condition for contributing to diabetes management.