Diabetes Metab J.  2024 Jul;48(4):790-801. 10.4093/dmj.2023.0298.

Enhancing Diabetes Care through a Mobile Application: A Randomized Clinical Trial on Integrating Physical and Mental Health among Disadvantaged Individuals

• Bae JH
• Park EH
• Lee HK
• Yoon KH
• Won KC
• Kim HM
• Kim SG

• KMID: 2558046
• DOI: http://doi.org/10.4093/dmj.2023.0298

Abstract

Background
This study examines integrating physical and mental healthcare for disadvantaged persons with type 2 diabetes mellitus and mild-to-moderate depression in the community, using a mobile application within a public-private-academic partnership.
Methods
The Korean Diabetes Association has developed a mobile application combining behavioral activation for psychological well-being and diabetes self-management, with conventional medical therapy. Participants were randomly assigned to receive the application with usual care or only usual care. Primary outcomes measured changes in psychological status and diabetes selfmanagement through questionnaires at week 12 from the baseline. Secondary outcomes assessed glycemic and lipid control, with psychological assessments at week 16.
Results
Thirty-nine of 73 participants completed the study (20 and 19 in the intervention and control groups, respectively) and were included in the analysis. At week 12, the intervention group showed significant reductions in depression severity and perceived stress compared to the control group. Additionally, they reported increased perceived social support and demonstrated improved diabetes self-care behavior. These positive effects persisted through week 16, with the added benefit of reduced anxiety. While fasting glucose levels in the intervention group tended to improve, no other significant differences were observed in laboratory assessments between the groups.
Conclusion
This study provides compelling evidence for the potential efficacy of a mobile application that integrates physical and mental health components to address depressive symptoms and enhance diabetes self-management in disadvantaged individuals with type 2 diabetes mellitus and depression. Further research involving larger and more diverse populations is warranted to validate these findings and solidify their implications.

Keyword

Behavior therapy; Depression; Diabetes mellitus, type 2; Healthcare disparities; Health inequities; Mobile applications; Pilot projects; Public-private sector partnerships; Randomized controlled trials as topic

Figure

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  Fig. 1. Trial profile.

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  Fig. 2. Changes in psychologic status questionnaire scores. (A) Korean version of the Perceived Stress Scale (K-PSS) change from baseline. (B) K-PSS. (C) Brief Diabetes Distress Screening Instrument (DDS-2) change from baseline. (D) DDS-2. (E) Patient Health Questionnaire-9 (PHQ-9) change from baseline. (F) PHQ-9. Data are means (with error bars showing standard errors). aP<0.05 for the difference to baseline within each group, bP<0.05 for the difference between the groups within each visit.

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  Fig. 3. Changes in diabetes self-management questionnaire scores. (A) Diabetes Care Profile-Social Support Scale (DCP-SSS) change from baseline. (B) DCP-SSS. (C) Diabetes Self-Management Behaviors for Older Koreans (DSMB-O) change from baseline. (D) DSMB-O. (E) Diabetes Self-Efficacy Scale (DSES) change from baseline. (F) DSES. Data are means (with error bars showing standard errors). aP<0.05 for the difference to baseline within each group.

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