Patients with diabetes, CKD respond well to telehealth counseling, nutrition app
Patients with type 2 diabetes and chronic kidney disease saw improvements in blood pressure, self-reported sodium intake and diet quality after using a smartphone nutrition app and attending telehealth counseling.
“The evidence behind using smartphone apps to deliver behavioral health interventions remains limited, particularly in patients with multiple comorbidities such as type 2 diabetes and CKD,” Alex R. Chang, MD, MS, assistant professor at the Kidney Health Research Institute and department of population heath sciences at Geisinger, told Healio. “This study sought to examine whether use of a nutrition app combined with dietary counseling via telephone with a nutritionist could help patients improve their sodium intake, dietary quality and blood pressure over 12 months.”
In a single center, single arm study, researchers observed 44 participants (mean age 60.3 ± 11.9 years; 43% were women; 89% were white; median eGFR was 78.5 mL/min/1.73 m2; median urine albumin excretion 52.9 mg/day; 84% had hypertension) with type 2 diabetes and stage 1 to 3 CKD.
For 8 weeks, participants used MyFitnessPal to record their dietary data and communicate with registered dietitians for weekly telephone counseling. Counseling was in the form of motivational interviewing.
After the 8-week intervention, follow-ups occurred at 6 and 12 months to collect 24-hour urine sodium (two collections per timepoint), Healthy Eating Index 2015 score (three 24-hour dietary recalls per timepoint), 24-hour systolic blood pressure (SBP), 24-hour diastolic blood pressure (DBP) and 24-hour urine albumin excretion.
Among the 44 participants, only 32 completed the 8-week intervention, 27 attended the 6-month follow-up and 25 finished the 12-month follow-up. Those who completed the 12-month follow-up reported sodium intake decreased by 638 mg/day from baseline of 2,919 mg/day.
While the 24-hour mean urine sodium and albumin excretion did not lower during the study period, the Healthy Eating Index 2015 score improved by 7.76 points at 12 months from a mean baseline of 54.6. Additionally, both 24-hour SBP and DBP decreased at 12 months from baseline.
“This study shows that patients with diabetes and chronic kidney disease who receive telecounseling from a dietitian combined with the use of a smartphone nutrition app, can improve their dietary quality and blood pressure over 12 months,” Chang told Healio. “If these improvements in blood pressure and dietary quality can be sustained over the long-term, one would expect this to translate into reduced risk of cardiovascular disease.”
Researchers noted future research studies are needed to determine whether remotely delivered dietary interventions can significantly improve kidney health over time.