Featured on CNA938: Could smartphone-based apps like nBuddy be effective in controlling diabetes?

The first lifestyle management app backed by clinical studies and scientific evidence, nBuddy Diabetes is developed by HeartVoice, a member of iAPPS Health Group, and was conceptualised by NUH Chief Dietitian Dr. Lim Su Lin. 

As reported in 4 peer-reviewed journals published within the past 2 years, nBuddy is proven to be effective in promoting positive behavioural change for weight and chronic disease management.

Dr. Lim Su Lin was recently invited to speak with Daniel Martin on CNA938’s Health Matters about her latest study, which involved a randomised clinical trial with Asian adults with Type 2 Diabetes.

Scroll down to read through what they discussed!

Daniel Martin (DM):
Type 2 Diabetes – it’s a major public health problem all over the world. In Singapore, something like 640,000 people suffer from Diabetes. Could Lifestyle Interventions really be effective in Diabetes Management? A team of researchers, led by Dr. Lim Su Lin, Chief Dietitian from NUH, carried out a randomised clinical trial to compare the effects of a culturally contextualised smartphone-based intervention compared to usual care on weight and metabolic outcomes.

Sharing with us the study’s key findings and the effectiveness of something known as the Nutritionist Buddy Diabetes app, lead researcher – the aforementioned Dr. Lim Su Lin – is here. Dr Lim, welcome to the show!

Dr. Lim Su Lin (SL): Hello, Daniel!

DM: I’m very intrigued about what dent this could make in our war on diabetes. Talk to me about the nature of the clinical trial — how were you able to test the effectiveness of something like this?

SL: Firstly, I want to say – did you know despite so many smartphone-based apps on diets and healthy living, there are just very few of them based on clinical studies?

DM: No, and that’s a worrying thing right? That means a lot of people are using these apps that don’t have a lot of real evidence behind them.

SL: Yes, so I’m very happy to say that this is indeed the first randomised controlled trial in Singapore using a smartphone-based lifestyle intervention on people with Diabetes, and we know that randomised controlled trials provide the highest level, which is the Level 1 evidence for therapeutic studies.

DM: What did the study try to establish? How did the clinical trial get underway? What was the conduct of it?

SL: Because it was a randomised controlled trial, we randomised participants either to the intervention — which is the mobile app group — and the control group. They get either one randomly, and both the control and intervention participants received the diet and physical advice from a dietitian at baseline.

However, additionally, for the Intervention participants, they were advised to download the nBuddy Diabetes or the Nutritionist Buddy app and use them. For the benefit of listeners who may not be familiar with the nBuddy Diabetes app, it is a clinical-grade app which incorporates evidence-based behavioural modification strategies to promote weight loss and diabetes control.

Some of the key features: it has a database of more than 14,000 food items which are localised to a Singapore context, and it can also evaluate the suitability of food choices and provides a healthier alternative if the food chosen is not the best choice — this is actually a unique feature. Another unique feature is that it provides a prompt when a user exceeds their calorie or carbohydrates limits. This helps people to understand their diet – whether they exceeded their carbohydrates and things like that.

DM: What did the study establish — was it able to find that it was effective, that using the app had a greater result than just the control?

SL: Yes, very! In fact, some of the results fascinated us. We especially want to highlight the good results of participants who initially had poor diabetes control at baseline, because they benefited the most significantly. These people benefited from the mobile app intervention with a 1.8% reduction in HbA1c. HbA1c is an indicator of the average 3 months blood sugar control. This insight shows that it’s greater than the improvement of about 1% achieved in most oral diabetes medications, as reported in many studies. To our surprise, the reduction in blood sugar was also achieved alongside significant reductions in diabetes medication in the mobile app group. That means besides blood sugar being controlled and dropped, they also end up reducing their diabetes medication. In the study, usually we worry about – maybe the blood sugar dropped because the doctor increased the medication, but the good thing was that we actually took note of the medications the patients are taking and any changes to the medications along the intervention.

DM: How lovely to hear! It’s not just about minor improvements — it could lead to even some major life changes, potentially, and measurable at that! I’m curious though, because of our diverse population, our elderly population, people with language capacities and different languages spoken in Singapore, how user friendly is this app would you say in terms of user interface and the ability to reach different demographics?

SL: Of course, there will be people who are not very tech savvy, so maybe they may not benefit so much from this, but we have quite many elderly participants above 65 years old and they have benefited from it too — as long as they’re willing to use the app. The good thing is that even for the Malay population, if the type in a Malay word, the app will be able to translate and come up with a list of the items they’re looking for. So many of our elderly participants have benefited from it, that’s what I can say.

DM: So language support is there for English and Malay. What about Mandarin?

SL: For those who are solely Mandarin-speaking or can only read Mandarin, we haven’t really tackled this group yet. But Broken English is fine — as long as people can speak Simple English, we are okay with that and they are able to use the app. 

DM: That sounds great! What’s the availability like? Can somebody download and use it right now?

SL: This app is available to the public in the App Store and Play Store with basic features accessible for free to the public, so they can download it right now. 

DM: And is there a paid option or something like that?

SL: If they want to upgrade to a Pro version, then there will be certain features that will be accessible to them like Daily Tips and Carbohydrates Listing. For those who pay the Premium, they even get nutritionist support and videos available for them. 

DM: Ah, that’s the thing, because coming from the Dietetics department, I was wondering whether this is an opportunity to have a form of remote connection with the patients in a way.

SL: That’s exactly what we did in this study — participants were able to connect with the Dietitians through the app. So this is one of the features we have in this app, with the Premium version. The Pro is without the support from the Dietitian, but the Premium is. But the Pro has a few other features available. Basic is good enough if they want to download it for free and try it out first, just go ahead – there’s no obligation that they have to pay for it and things like that. A lot of people are downloading it and using it for free actually!

DM: I’m sure! You know what? If it’s good advice, if it’s backed up by research like you said and a clinical trial behind it in terms of its potential impact, what a great opportunity. Dr. Lim Su Lin, the Chief Dietitian from the National University Hospital — a smartphone-based lifestyle intervention app for weight and blood sugar control in Type 2 Diabetes patients.

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