My Diabetes Coach, a Mobile App-Based Interactive Conversational Agent to Support Type 2 Diabetes Self-Management: Randomized Effectiveness-Implementation Trial.

Enying Gong,Paul Scuffham,Mojtaba Lotfaliany,Shaira Baptista,Anthony Russell,Emily Williams,Brian Oldenburg,Dominique Bird,Jane Speight,Michaela Riddell

doi:10.2196/20322

Abstract

BackgroundDelivering self-management support to people with type 2 diabetes mellitus is essential to reduce the health system burden and to empower people with the skills, knowledge, and confidence needed to take an active role in managing their own health.ObjectiveThis study aims to evaluate the adoption, use, and effectiveness of the My Diabetes Coach (MDC) program, an app-based interactive embodied conversational agent, Laura, designed to support diabetes self-management in the home setting over 12 months.MethodsThis randomized controlled trial evaluated both the implementation and effectiveness of the MDC program. Adults with type 2 diabetes in Australia were recruited and randomized to the intervention arm (MDC) or the control arm (usual care). Program use was tracked over 12 months. Coprimary outcomes included changes in glycated hemoglobin (HbA1c) and health-related quality of life (HRQoL). Data were assessed at baseline and at 6 and 12 months, and analyzed using linear mixed-effects regression models.ResultsA total of 187 adults with type 2 diabetes (mean 57 years, SD 10 years; 41.7% women) were recruited and randomly allocated to the intervention (n=93) and control (n=94) arms. MDC program users (92/93 participants) completed 1942 chats with Laura, averaging 243 min (SD 212) per person over 12 months. Compared with baseline, the mean estimated HbA1c decreased in both arms at 12 months (intervention: 0.33% and control: 0.20%), but the net differences between the two arms in change of HbA1c (−0.04%, 95% CI −0.45 to 0.36; P=.83) was not statistically significant. At 12 months, HRQoL utility scores improved in the intervention arm, compared with the control arm (between-arm difference: 0.04, 95% CI 0.00 to 0.07; P=.04).ConclusionsThe MDC program was successfully adopted and used by individuals with type 2 diabetes and significantly improved the users’ HRQoL. These findings suggest the potential for wider implementation of technology-enabled conversation-based programs for supporting diabetes self-management. Future studies should focus on strategies to maintain program usage and HbA1c improvement.Trial RegistrationAustralia New Zealand Clinical Trials Registry (ACTRN) 12614001229662; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614001229662

Highlights

Type 2 diabetes mellitus (T2DM) is a common chronic condition that places a significant burden on individuals and the health care system
The My Diabetes Coach (MDC) program was successfully adopted and used by individuals with type 2 diabetes and significantly improved the users’ health-related quality of life (HRQoL). These findings suggest the potential for wider implementation of technology-enabled conversation-based programs for supporting diabetes self-management
Participants who had an incomplete survey without a valid Assessment of Quality of Life-8 Dimensions CONSORT (AQoL-8D) score were younger (P=.02) and more likely to be allocated to the intervention arm (P=.007)

Summary

Introduction

Type 2 diabetes mellitus (T2DM) is a common chronic condition that places a significant burden on individuals and the health care system. Delivering self-management support to people with T2DM is essential to reduce the health system burden and to empower people with the skills, knowledge, and confidence needed to take an active role in managing their own health [3]. Health coaching programs, incorporating continuous feedback and reinforcement [4] delivered to people with diabetes by health care professionals, have been shown to be an effective strategy to improve glycemic management [3,5]. The emergence of information and communication technologies in recent years offers the potential to deliver such programs at scale and with relatively low costs [6]. Delivering self-management support to people with type 2 diabetes mellitus is essential to reduce the health system burden and to empower people with the skills, knowledge, and confidence needed to take an active role in managing their own health

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