A brief, habit-based weight loss intervention using mobile application for overweight Chinese adults with pre-diabetes: A pilot study

Dr Ho, Man Mandy   (Principal Investigator (PI))

Dr Chau Pui Hing   (Co-Investigator)

Dr Yu Yee Tak Esther   (Co-Investigator)

Dr Ying Tin Cheung, Michael   (Co-Investigator)

18

2018-05-01

2019-10-31

63460

A brief, habit-based weight loss intervention using mobile application for overweight Chinese adults with pre-diabetes: A pilot study

brief intervention, habit formation theory, lifestyle intervention, Pre-diabetes, Weight loss

Nursing,Diabetes/Metabolism

201711159271

Seed Fund for PI Research – Basic Research

2017

Completed

Type 2 diabetes (T2DM) is a major non-communicable disease and one of the world’s fastest growing health problem. In 2013, T2DM affected more than 380 million around the world and the number is expected to rise to 592 million in 2035 and many cases are undiagnosed. (1) T2DM is associated with significant morbidity, including increased risk of cardiovascular diseases (CVD), stroke, hypertension, retinopathy, blindness, renal failure and leg amputation, (2) which place an enormous burden on individuals, society and the healthcare system. The Asia-Pacific region carries a high disease burden, with more than 60% of the global diabetic population living in Asian region. (3) Asians have a strong ethnic and genetic predisposition for T2DM and develop T2DM at a lower degree of obesity and at younger ages than other population groups. (4) Importantly, the prevalence of T2DM and related complications continue to increase and many cases are undiagnosed, resulting in a rising disease burden. (5) T2DM is a non-reversible, yet a preventable condition. The onset of T2DM is gradual, with most individuals progressing through a state of pre-diabetes. A National Survey conducted in China in 2010 revealed that 50.1% of people aged 18 or older have pre-diabetes. (5) Of particular concern is the evidence suggesting that without targeted intervention, the progression from pre-diabetes to T2DM is faster in Asians than in Caucasians. (6, 7) People with pre-diabetes, defined as having impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and/or impaired glycated haemoglobulin (HbA1C), are at increased risk of developing T2DM and its associated complications, especially CVD, which can develop even in the absence of progression to overt T2DM. (8-10) CVD is the leading cause of mortality and the most prevalent cause of death in diabetic populations. Diabetes confers about a two-fold excess risk for vascular diseases and account for 11% of vascular death in populations in developed countries. (11) Evidence suggests that the risk of CVD in individuals with pre-diabetes is similar to those with overt diabetes. Individual with pre-diabetes have at least 20% increased risk of developing CVD compared to those with normal glucose tolerance.(12, 13) Hence, it is essential that people with pre-diabetes are targeted for early intervention to prevent T2DM and related complications, particularly the CVD complications. Despite the recognised importance of intervention at the pre-diabetes stage, data on the effectiveness strategies targeting overweight Chinese adults with pre-diabetes in local setting is limited. Overweight and obesity is a major risk factor of T2DM. International trials demonstrate that lifestyle interventions (which includes diet, physical activity and behavioural modification components) targeting at least 5% weight loss in individuals with pre-diabetes can effectively decrease the incidence T2DM. (14-16) However, current approaches of lifestyle intervention (group-based intervention and/or individual face-to-face consultation) are usually labour intensive, require considerate expertise from the health professional and a high level of commitment from the patients. It may limit the compliance and widespread adoption and of lifestyle intervention as first-line intervention for individuals with pre-diabetes. In addition, the rate of diabetes has increased rapidly and significantly among younger populations who may be less motivated and practically difficult to attend face-to-face lifestyle intervention programme. Hence, it is important to identify simple, low cost, theory-based and innovative strategies to maximize coverage and compliance. A randomised trial conducted within obese populations suggest that participants receiving a 3-month brief intervention based on habit-formation model using printed materials can were more likely to achieve 5% weight loss compared to those receiving usual care provided by primary care physicians (odds ratio 2.16, 95% confidence interval: 1.14 – 4.12) and had maintained their weight loss at 24 month follow up. (17) Growing evidence suggests that mobile phones may be a promising platform for enhancing self-management and improving clinical outcomes in patients with chronic diseases.(18) However, the effect of a brief, weight loss intervention based on habit-formation model using mobile app has not been tested with overweight prediabetic population. Our research team is currently developing a mobile app based on habit formation theory (19) and behaviour change theory(20) for individuals with pre-diabetes. This pilot study will be the first study to explore the feasibility and effect of a culturally appropriate brief weight loss intervention using mobile apps for Chinese overweight adults with pre-diabetes. The specific objectives of this pilot study are: 1. To develop an mobile apps for Chinese adults with pre-diabetes using habit formation and behaviour change theory 2. To evaluate the feasibility of implementing a brief weight loss intervention using mobile apps for overweight Chinese adults with pre-diabetes; 3. To explore the effect of a brief weight loss intervention programme on weight loss and improving insulin sensitivity and metabolic profiles and slowing the progression of carotid intima-media thickness in Chinese adults with pre-diabetes