Diabetic kidney disease, a significant complication of diabetes, remains the leading cause of kidney failure among diabetes patients. A recent study published in 'Npj Digital Medicine' highlights the potential of mobile health (mHealth) to address this challenge effectively. The research reveals that the 'DialBetesPlus' self-management support system can significantly improve renal outcomes in patients with diabetic kidney disease by enhancing patient control over diet and exercise.

      The 12-month randomized trial, enrolled 126 patients with type 2 diabetes mellitus and with moderately increased albuminuria (urinary albumin-to-creatinine ratio (UACR): 30-299 mg/g creatinine). These patients were recruited from eight clinical sites in Japan. Detailed information to improve patient control over exercise and dietary behaviours were provided to the patients using a Theory of Planned Behavior (TPB) behavior change theory framework Participants in the intervention group received DialBetesPlus, a self-management support system that monitors exercise, blood glucose, diet, blood pressure, and body weight through a smartphone application, in addition to standard care. The primary outcome, measured as the change in UACR after 12 months, showed a 28.8% improvement in the intervention group compared to the control group (P = 0.029). Secondary outcomes also showed positive results, with the intervention group experiencing a 0.32-point better change in HbA1c (P = 0.041).

      These significant improvements persisted even when the models were adjusted to account for the co-administration of drugs targeting albuminuria (GLP-1 receptor agonists, SGLT-2 inhibitors, ACE inhibitors, and ARBs), with a UACR difference of −32.3% [95% CI: −49.2%, −9.8%] between groups (P = 0.008). Exploratory multivariate regression analysis indicated that the improvements were primarily due to levels of exercise.

      This study marks the first of its kind that demonstrates a lifestyle intervention via mHealth can achieve clinically significant improvements in moderately increased albuminuria, paving the way for innovative approaches in managing diabetic kidney disease and preventing renal and cardiovascular complications.

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