A new research study found that a smartphone app usage caused reduction in blood sugar levels in people with Type 2 diabetes. CBT(Cognitive behavioral therapy) was provided through a smartphone app. The study concluded that people who took CBT required less diabetes medication at six months, compared to those who only received standard diabetes care & a control app.
This trial shows clear “dose effect” between app-based cognitive behavioral therapy lessons & improvement in blood sugar levels.
In this study, people with Type 2 diabetes were given a smartphone app that delivered a personalized cognitive behavioral therapy (CBT) & it was found that these people showed significantly greater reductions in their blood sugar & less need for higher doses of diabetes medications at six months compared to those who only received standard diabetes care and a control app.
This is according to a study which is yet to be presented at the American College of Cardiology’s Annual Scientific Session. A clear “dose effect” was seen, in patients completing more CBT lessons seeing the maximum benefits.
When studied in a large randomized controlled trial, digital CBT designed to the individual, was able to reduce blood sugar levels, while also reducing the need for intensified medication use & improving blood pressure and body weight too.
Digital CBT also had a positive effect on other aspects like depression & quality of life scores over six months.
What is CBT of smartphone app?
Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that aims to help individuals identify & change negative thought behavioral patterns that can contribute to mental health problems & can interfere in the person’s ability to fight with the disease in many ways. It is a short-term & goal-oriented approach which encourages individuals to actively participate in their own treatment.
This is one of the first digital therapeutics to show great efficacy for lowering blood sugar in a rigorous randomized controlled trial & has the potential to become one of the first prescription digital therapeutics for diabetes.
Lifestyle modification is the real foundation of diabetes management. A healthy lifestyle is utmost to reduce blood sugar levels & the long-term consequences of elevated blood sugar, which can include high blood pressure, heart disease & stroke.
Doctors & dietitians have been struggling to help patients achieve effective lifestyle change. The traditional one-on-one CBT delivered in a therapist’s office has been shown to be effective, but it is quite expensive & it may not be covered by health insurance. Access to CBT can also be limited by the availability of therapists & the need to travel to the therapist’s office.
Majority of diabetes is the outcome of unhealthy behaviors—making poor food choices, overeating, stress eating & not exercising. All these are outcomes of unhelpful patterns of thinking & modes of coping with environmental stresses.
CBT has been practically found to be effective at helping people develop the skills to recognize the unhelpful thoughts & beliefs that trigger their unhealthy behaviors & to establish healthier patterns of thinking & behavior.
The trial involved 668 people with diabetes whose average age was 58 years & average body mass index (BMI) was 35. A BMI of 30 or higher falls within the obesity range. At the beginning of the study, participants were taking an average of two medications to control blood sugar levels. Their median level of hemoglobin A1c (HbA1c), a measure of average blood sugar levels over the past three months, was 8.1%. The threshold for a diagnosis of diabetes is over 6.5%. Participants were told to have a smartphone.
The purpose of the trial was to know if a CBT program for diabetes that was automated & personalized would be effective. The CBT program was available on a smartphone & it could deliver benefit through lessons & skills and was individually tailored through a process of asking questions.
Half of the participants were randomly assigned to the CBT app & 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 which was aimed at skill development & behavior change but could complete more lessons if they wished.
The primary endpoint seen was the change in HbA1c levels at three & six months. Secondary endpoints included changes in patient-reported outcomes such as depression & quality of life. Changes in the use of medication to control blood sugar was an exploratory endpoint (an endpoint included to explore a new hypothesis).
Results of CBT use
At three months, participants assigned to the CBT app saw a reduction in HbA1c of 0.4%, which was statistically quite significant & similar in magnitude to what is achieved with most antihyperglycemic medications.
At six months, these participants maintained the reduction, which remained significantly lower than the control group. At the end of the study, 24% of the patients in the control group had an increase in medical therapy compared with 14.4% in the test group. In addition, while more participants in the control group started insulin or even increased their dose, more participants in the test group discontinued insulin or were even able to lower their dose.
A clear dose effect with digital CBT was seen. The antihyperglycemic effect increased in direct proportion to the number of lessons completed by the participants. The more lessons they covered, the greater the reductions in HbA1c they achieved.
The CBT program was not at all time consuming with users typically spending less than six minutes a day in using the app.
Follow-up studies will be conducted to learn more about the impacts of digital cognitive behavioral therapy in different delivery models & for longer duration.
