Deploying glucose and physical activity self-monitoring technologies to people at moderate-to-high risk of developing Type 2 Diabetes: a randomised feasibility trial
Self-monitoring of behaviour (namely diet and physical activity) and physiology (namely glucose) have been shown to be effective in type 2 diabetes (T2D) and prediabetes prevention. By combining self-monitoring technologies, the acute physiological consequences of behaviours could be shown; prompting greater consideration to physical activity levels today which impact risk of developing diabetes years or decades later. However, until recently, it has not been possible to show people the immediate harms of unhealthy lifestyle behaviours in real-time during daily life. The aim of the study was to assess user engagement, feasibility and acceptability of providing two commercially available self-monitoring technologies.
Forty-five adults aged ≥40 years, who owned a compatible Android smartphone and were at moderate-to-high risk of developing T2D (calculated using Leicester Risk Assessment Tool) were recruited in Leicestershire. HbA1c was measured using an Afinion Analyser to identify diabetes status. All participants were given a Fitbit Charge 2 to monitor physical activity and Freestyle Libre (FL) flash glucose monitors to monitor glucose for 42 days. Each FL sensor had a maximum lifespan of 2 weeks. Participants were randomly allocated 1:1:1 to either:
1. Glucose feedback (4 weeks) followed by glucose and physical activity feedback (2 weeks)
2. Physical activity feedback (4 weeks) followed by glucose and physical activity feedback (2 weeks)
3. Glucose and physical activity feedback (6 weeks)
Primary outcome measures were time spent on the two monitors’ smartphone applications, number of FL scans and changes to physical activity goals. Secondary outcomes included intervention feasibility (e.g. number of FL displacements) and acceptability (e.g. monitor wear and missing data).
All 45 participants completed the study (56±8.7 years, 60% were female, 8607±4590 steps at baseline, 16% high-risk and 7% had prediabetes). Engagement: Time spent on the Fitbit and FL applications declined over the six weeks across the three groups. A total of 10,582 scans of the FL sensor (equating to 7.2 scans/day) were recorded and 13 participants (23.9%) changed ≥1 of the physical activity goals. Feasibility: 23 participants (51.1%) required additional FL sensors and a total of 41 sensors were declared faulty or displaced during the study (average 1.78 sensors not lasting lifespan). Acceptability: Participants provided Fitbit data on 40.1±3.2 days and 9 (20%) and 24 participants (53.3%) received a prompt to charge or sync the Fitbit, respectively.
Technological problems were prevalent and must be overcome if such technologies are to be adopted into routine care. That said, findings suggest people at moderate-to-high risk of developing T2D were highly compliant in wearing the monitors and engaged with the self-monitoring technologies, but with engagement diminishing over time. The findings showed it is feasible to recruit people at moderate-to-high risk of T2D to a digital health intervention providing physical activity and glucose feedback.