Using mHealth to Optimize Glycaemic Control In Adults With Type 2 Diabetes In Low-Income Settings

Kenya is among the low- and middle-income countries in the world that are facing the overlapping burdens of malnutrition. This phenomenon is characterized by the coexistence of undernutrition, overweight, obesity, or diet-related noncommunicable diseases in individuals, households, and populations. Undernutrition includes micronutrient deficiencies, wasting, and stunting. On a positive note, though, Kenya has made progress towards meeting the global nutrition targets for wasting and stunting. However, Kenya is reported to have high zinc and iron micronutrient deficiencies, estimated to affect 74.8% and 21.9% of the population, respectively. It is also estimated that approximately 0.52 million adults aged 20–79 have diabetes, while nearly 44.1% of these have undiagnosed diabetes (6). Dietary behavior has been associated with the rising diabetes trends in Kenya, with 99.8% of the population consuming less than 5 servings of fruits per day.  Despite the high prevalence of diabetes in Kenya, there is scarce evidence on dietary behavior and food environments. Behavior change techniques have been associated with clinically significant improvements in glycated hemoglobin (HbA1C) in people with type 2 diabetes mellitus. This study therefore aims to optimize dietary behavior and the food environment to improve zinc, iron, and fasting glucose among adults with type 2 diabetes mellitus. This work shall be done in four work packages: i) explore the perceived dietary behavior and food environment through a qualitative descriptive study; ii) develop mobile applications and packages on health information for structured and systematic application in an interventional randomized controlled trial; iii) conduct a randomized controlled trial to optimize dietary behavior through mobile phone applications and peer support groups; and iv) establish how various variables influence the outcomes of dietary behavior using mediation analysis. It is envisioned that this study will provide insight into dietary behavior change strategies and recommendations to improve the efficiency of patient support groups and the innovative use of mobile technology for people with type 2 diabetes mellitus in low and middle-income countries.