Currently submitted to: JMIR mHealth and uHealth
Date Submitted: Feb 7, 2024
Open Peer Review Period: Feb 12, 2024 - Apr 8, 2024
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Using mHealth and Food Literacy to Optimize Glycaemic Control in Adults with Type 2 Diabetes in Kenya: An Exploratory Trial
ABSTRACT
Background:
The prevalence of Type 2 Diabetes (T2D) is increasing at alarming rates in Low- and Middle-Income Countries (LMICs), including Kenya.
Objective:
The objective of this study is to optimize glycaemic control in adults with T2D in Kenya using mHealth by improving food literacy
Methods:
We conducted an exploratory trial in adults with T2D in two rural hospitals in Kenya. Participants were randomly selected from two hospitals. Each hospital was assigned to the mHealth intervention or control group. Participants in the intervention group received mobile text messages through a bulk SMS API (Short Message Service Application Programming Interface). Participants in the control group received monthly appointment reminders (= attention control). Participants in both groups continued receiving routine standard of care. Baseline and endline data were collected through face-to-face sessions. The primary endpoint was glycated haemoglobin (HbA1c). Secondary outcomes were food literacy and Fasting blood glucose. Intention-to-treat analyses were performed using linear mixed models.
Results:
A total of 84 participants were recruited; 42 were assigned to the intervention group and 42 to the control group. A total of 57 (67.8%) participants (intervention: 29, control: 28) completed the study. After 12 weeks, univariate analysis showed that HbA1c remained stable in both groups. The difference with baseline measurement in the intervention group was 0.43% [from 10.02% (SD ±3.01) to 10.45% (SD ±3.22), P=.250] compared to 0.80% [from [10.62 (±3.35) to 11.42 (±3.25), P=.414]] in the control group. After multiple linear modelling, with age and education as random factors, the overall intervention effect for HbA1c was 0.19% (95% CI -0.82; 2.21) P=.846. For food literacy, the intervention group had a higher non-significant mean score after 12 weeks [53.5% (SD ±9.2) to 60.7% (±8.3), P=.012] compared to the control group [58.7% (±9.3) to 59.9% (±11.2), P=.767]. Fasting blood glucose did not significantly change.
Conclusions:
Although this study did not provide evidence on the effect of glycaemic control through food literacy for adults with Type 2 Diabetes, a focus on food literacy to improve dietary quality is still needed given its significant potential on dietary behaviour. Future research should pay attention to active patient involvement in the design and development of mHealth interventions, tracking behaviour and patient-centred outcomes, involving healthcare workers, and having a bi-directional approach. Clinical Trial: www.ClinicalTrials.gov (NCT05013294)
Citation
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