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

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Enying Gong 1, Shaira Baptista 1 2, Anthony Russell 3 4, Paul Scuffham 5, Michaela Riddell 6, Jane Speight 1 2 7, Dominique Bird 4, Emily Williams 8, Mojtaba Lotfaliany 1, Brian Oldenburg 1

Main idea: The 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.

Abstract

Background: 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.

Objective: This 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.

Methods: This 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.

Results: A total of 187 adults with type 2 diabetes (mean 57 years, SD 10 years; 41.7% women) were recruited. MDC program users completed 1942 chats with Laura, averaging 243 min (SD 212) per person over 12 months. At 12 months, HRQoL utility scores improved in the intervention arm, compared with the control arm.

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