Summary of How a Smartphone App Lowers Blood Sugar and Improves Health Behaviors in Patients With Diabetes:
A six-month study conducted by the American College of Cardiology found that patients with Type 2 diabetes who were given a cognitive behavioural therapy (CBT) smartphone app saw “significantly greater reductions in their blood sugar and less need for higher doses of diabetes medications” than those who only had standard diabetes care with a control app. A clear “dose effect” was seen with patients completing more CBT lessons experiencing the most benefits. Healthcare workers have long struggled to help patients make effective lifestyle changes, something which experts attribute to negative thought patterns that affect behaviour. CBT has reportedly been shown to be effective in helping people develop healthier working habits.
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A new study has revealed that individuals with Type 2 diabetes, who used a personalized cognitive behavioral therapy (CBT) smartphone app, saw impressive reductions in their blood sugar levels and needed less diabetes medication at six months, compared to those who only received standard diabetes care and a control app. The study was presented at the American College of Cardiology’s Annual Scientific Session Together With the World Congress of Cardiology.
The study showed a clear “dose effect” between app-based cognitive behavioral therapy lessons and improvement in health. Specifically, patients completing more CBT lessons saw the greatest benefits. Marc P. Bonaca, MD, MPH, the study’s principal investigator, said, “When studied in a large randomized controlled trial, digital CBT tailored to the individual reduced blood sugar levels, while also reducing the need for intensified medication use and improving blood pressure and body weight.”
The trial involved 668 people with diabetes who had an average age of 58 years and an average body mass index (BMI) of 35. A BMI of 30 or higher falls within the obesity range. Fifty-six percent of those enrolled were women, 30% were Black and 15% were Latino. At study enrollment, participants were taking an average of two medications to control their blood sugar levels. Their median level of hemoglobin A1c (HbA1c), a measure of average blood sugar levels over the past two to three months, was 8.1%. The threshold for a diagnosis of diabetes is over 6.5%. Participants were required to have a smartphone.
“For this trial, we wanted to know if a CBT program for diabetes that was automated and personalised would be effective. We wanted something that users could access on a smartphone that would deliver benefit through lessons and skills and that would be individually tailored through a process of asking questions,” said Bonaca. Half of the participants were randomly assigned to the CBT app and half to a control app, which asked some questions but did not provide tailored lessons or skills. Those assigned to the CBT app were asked to complete one lesson per week aimed at skill development and behavior change, but they could complete more lessons if they wished.
At three months, participants assigned to the app saw a reduction in HbA1c of 0.4%, which was statistically significant and similar in magnitude to what is achieved with most antihyperglycemic medications. At six months, these participants maintained this reduction, which remained statistically significantly lower than the control group.
“We saw a clear dose effect with digital CBT,” Bonaca said. “That is, the antihyperglycemic effect increased in direct proportion to the number of lessons participants completed. The more lessons they did, the greater the reductions in HbA1c they achieved. Participants aged over 75 did as well as younger patients if they completed the same number of lessons.”
CBT has been shown to be effective in helping individuals develop the skills to recognize unhelpful thoughts and beliefs that trigger unhealthy behaviors and to establish healthier patterns of thinking and behavior. Lifestyle modification is the foundation of diabetes management to reduce blood sugar levels and the long-term consequences of elevated blood sugar, which can include high blood pressure, heart disease, and stroke. Healthcare professionals, however, have struggled to help patients achieve effective lifestyle change, particularly as traditional one-on-one CBT can be expensive and may not be covered by health insurance. Access to CBT is also limited by the availability of therapists and the need to travel to the therapist’s office.
Overall, this study has shown great promise in the form of personalized digital CBT for Type 2 diabetes management. This therapy has the potential to become one of the first prescription digital therapeutics for diabetes. Bonaca and his colleagues, as well as other groups, are conducting follow-up studies to learn more about the impacts of digital cognitive-behavioral therapy in different delivery models and for longer exposures.
