Association between mobile health app engagement and weight loss and glycemic control in adults with Type 2 diabetes and prediabetes (D'LITE Study): Prospective Cohort Study

Su Lin Lim, Melissa Hui Juan Tay, Kai Wen Ong, Jolyn Johal, Qai Ven Yap, Yiong Huak Chan, Genevieve Kai Ning Yeo, Chin Meng Khoo, Alison Yaxley

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3 Citations (Scopus)
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Background: Mobile health apps are increasingly used as early intervention to support behavior change for diabetes prevention and control, with the overarching goal of lowering the overall disease burden. Objective: This prospective cohort study conducted in Singapore aimed to investigate app engagement features and their association with weight loss and improved glycemic control among adults with diabetes and prediabetes from the intervention arm of the Diabetes Lifestyle Intervention using Technology Empowerment randomized controlled trial. Methods: Diabetes and prediabetes participants (N=171) with a median age of 52 years, BMI of 29.3 kg/m 2, and glycated hemoglobin (HbA 1c) level of 6.5% and who were being assigned the Nutritionist Buddy Diabetes app were included. Body weight and HbA 1c were measured at baseline, 3 months, and 6 months. A total of 476,300 data points on daily app engagement were tracked via the backend dashboard and developer’s report. The app engagement data were analyzed by quartiles and weekly means expressed in days per week. Linear mixed model analysis was used to determine the associations between the app engagements with percentage weight and HbA 1c change. Results: The median overall app engagement rate was maintained above 90% at 6 months. Participants who were actively engaged in ≥5 app features were associated with the greatest overall weight reduction of 10.6% from baseline (mean difference −6, 95% CI −8.9 to −3.2; P<.001) at 6 months. Adhering to the carbohydrate limit of >5.9 days per week and choosing healthier food options for >4.3 days per week had the most impact, eliciting weight loss of 9.1% (mean difference −5.2, 95% CI −8.2 to −2.2; P=.001) and 8.8% (mean difference −4.2, 95% CI −7.1 to −1.3; P=.005), respectively. Among the participants with diabetes, those who had a complete meal log for >5.1 days per week or kept within their carbohydrate limit for >5.9 days per week each achieved greater HbA 1c reductions of 1.2% (SD 1.3%; SD 1.5%), as compared with 0.2% (SD 1%; SD 0.6%). in the reference groups who used the features <1.1 or ≤2.5 days per week, respectively. Conclusions: Higher app engagement led to greater weight loss and HbA 1c reduction among adults with overweight or obesity with type 2 diabetes or prediabetes.

Original languageEnglish
Article numbere35039
Number of pages14
JournalJMIR Diabetes
Issue number3
Publication statusPublished - Jul 2022


  • engagement
  • diabetes
  • prediabetes
  • mobile health
  • mobile apps
  • weight loss
  • glycemic control
  • glycated hemoglobin
  • HbA1c change
  • mobile phone
  • mHealth


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