An Evaluation of Alternative Technology- Supported Counseling Approaches to Promote Multiple Lifestyle Behavior Changes in Patients With Type 2 Diabetes and Chronic Kidney Disease

Objectives: Although technology-supported interventions are effective for reducing chronic disease risk, little is known about the rela-tive and combined efficacy of mobile health strategies aimed at multiple lifestyle factors. The purpose of this clinical trial is to evaluate the efficacy of technology-supported behavioral intervention strategies for managing multiple lifestyle-related health outcomes in over-weight adults with type 2 diabetes (T2D) and chronic kidney disease (CKD).Design and Methods: Using a 2 3 2 factorial design, adults with excess body weight (body mass index >= 27 kg/m2, age >= 40 years), T2D, and CKD stages 2-4 were randomized to an advice control group, or remotely delivered programs consisting of synchronous group-based education (all groups), plus (1) Social Cognitive Theory-based behavioral counseling and/or (2) mobile self-monitoring of diet and physical activity. All programs targeted weight loss, greater physical activity, and lower intakes of sodium and phosphorus-containing food additives.Results: Of 256 randomized participants, 186 (73%) completed 6-month assessments. Compared to the ADVICE group, mHealth interventions did not result in significant changes in weight loss, or urinary sodium and phosphorus excretion. In aggregate analyses, groups receiving mobile self-monitoring had greater weight loss at 3 months (P 5 .02), but between 3 and 6 months, weight losses pla-teaued, and by 6 months, the differences were no longer statistically significant.Conclusions: When engaging patients with T2D and CKD in multiple behavior changes, self-monitoring diet and physical activity demonstrated significantly larger short-term weight losses. Theory-based behavioral counseling alone was no better than baseline advice and demonstrated no interaction effect with self-monitoring. (c) 2022 by the National Kidney Foundation, Inc. All rights reserved.

Automated summary

This clinical trial evaluated the efficacy of technology-supported behavioral intervention strategies for managing multiple lifestyle-related health outcomes in overweight adults with type 2 diabetes and chronic kidney disease. The results showed that self-monitoring diet and physical activity achieved significant short-term weight loss, while theory-based behavioral counseling alone did not have a significant effect.