Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.
Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
JMIR Aging. 2024 Sep 13;7:e53064. doi: 10.2196/53064.
Current clinical guidelines for the management of type 2 diabetes mellitus (T2DM) in older adults recommend the use of antihyperglycemic medications, monitoring of blood glucose levels, regular exercise, and a healthy diet to improve glycemic control and reduce associated comorbidities. However, adherence to traditional exercise programs is poor (<35%). Common barriers to adherence include fear of hypoglycemia and the need for blood glucose level monitoring before exercise. Digital health strategies offer great promise for managing T2DM as they facilitate patient-practitioner communication, support self-management, and improve access to health care services for underserved populations. We have developed a novel web-based software program allowing practitioners to create tailored interventions and deliver them to patients via digital voice assistants (DVAs) in their own homes.
We aim to evaluate the feasibility of a 12-week, home-based, personalized lifestyle intervention delivered and monitored by DVAs for older adults with obesity and T2DM.
In total, 50 older adults with obesity aged 50-75 years with oral hypoglycemic agent-treated T2DM were randomized to the intervention (DVA, n=25) or a control group (n=25). Participants allocated to the DVA group were prescribed a home-based muscle strengthening exercise program (~20- to 30-min sessions) and healthy eating intervention, delivered via DVAs (Alexa Echo Show 8; Amazon) using newly developed software ("Buddy Link"; Great Australian Pty Ltd). Control group participants received generalized physical activity information via email. Outcomes were feasibility, DVA usability (System Usability Scale), and objectively assessed physical activity and sedentary time (wrist-worn accelerometers).
In total, 45 (90%) out of 50 participants completed this study. Mean adherence to prescribed exercise was 85% (SD 43%) with no intervention-related adverse events. System usability was rated above average (70.4, SD 16.9 out of 100). Compared with controls, the DVA group significantly decreased sedentary time (mean difference -67, SD 23; 95% CI -113 to -21 min/d), which was represented by a medium to large effect size (d=-0.6).
A home-based lifestyle intervention delivered and monitored by health professionals using DVAs was feasible for reducing sedentary behavior and increasing moderate-intensity activity in older adults with obesity and T2DM.
Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000307808; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381364&isReview=true.
目前，针对老年 2 型糖尿病患者的临床指南建议使用降血糖药物、监测血糖水平、定期运动和健康饮食来改善血糖控制并减少相关合并症。然而，传统运动方案的依从性很差（<35%）。依从性的常见障碍包括对低血糖的恐惧和运动前需要监测血糖水平。数字健康策略为管理 2 型糖尿病提供了巨大的前景，因为它们促进了医患沟通，支持自我管理，并改善了服务不足人群获得医疗保健服务的机会。我们开发了一种新的基于网络的软件程序，允许医生为患者创建量身定制的干预措施，并通过数字语音助手（DVA）在患者自己的家中为其提供这些干预措施。
我们旨在评估一种为期 12 周的、基于家庭的、针对超重和 2 型糖尿病老年患者的个性化生活方式干预措施，通过 DVA 进行干预和监测的可行性。
共有 50 名年龄在 50-75 岁之间、服用口服降糖药的 2 型糖尿病肥胖患者被随机分为干预组（DVA，n=25）或对照组（n=25）。分配到 DVA 组的患者被规定进行家庭肌肉强化运动方案（~20-30 分钟/次）和健康饮食干预，通过新开发的软件（“Buddy Link”；Great Australian Pty Ltd）通过 DVA（亚马逊的 Alexa Echo Show 8）进行。对照组患者通过电子邮件获得一般的体育活动信息。评估指标包括可行性、DVA 的可用性（系统可用性量表）以及客观评估的身体活动和久坐时间（腕戴式加速度计）。
共有 50 名参与者中的 45 名（90%）完成了这项研究。规定运动的平均依从率为 85%（SD 43%），没有与干预相关的不良事件。系统可用性评分高于平均水平（70.4，SD 16.9 分，满分 100 分）。与对照组相比，DVA 组的久坐时间显著减少（平均差异-67，SD 23；95%CI-113 至-21 分钟/天），这表示具有中到大的效果量（d=-0.6）。
由专业医疗保健人员通过 DVA 提供和监测的基于家庭的生活方式干预措施，对于减少肥胖和 2 型糖尿病老年患者的久坐行为和增加中等强度活动是可行的。
澳大利亚和新西兰临床试验注册中心（ANZCTR）ACTRN12621000307808；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381364&isReview=true。
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