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. 2020;59(1):45-53.
doi: 10.2169/internalmedicine.3150-19. Epub 2020 Jan 1.

Effectiveness of Lifestyle Intervention Using the Internet of Things System for Individuals with Early Type 2 Diabetes Mellitus

Sawako Kato  1 , Masahiko Ando  2 , Hiroyuki Honda  3 , Yasuko Yoshida  3 , Takahiro Imaizumi  1 , Naoki Yamamoto  4 , Shoichi Maruyama  1
Affiliations

Effectiveness of Lifestyle Intervention Using the Internet of Things System for Individuals with Early Type 2 Diabetes Mellitus

Sawako Kato et al. Intern Med. 2020.

Abstract

Objective Exercise therapy is used for glycemic control in type 2 diabetes mellitus (T2DM). We evaluated the effects of intensive health guidance using the Internet of things (IoT) among Japanese company workers with early T2DM. Methods Fifty-three men (mean age: 54 years) with glycated hemoglobin (HbA1c) levels of >6.5% were enrolled in a 6-month exercise therapy program between August 2016 and January 2017. They used activity meters, scales, and sphygmomanometers connected to the Internet by Bluetooth. These devices automatically and continuously recorded daily information, and the participants simultaneously received health guidance from a public health nurse twice a month. Results The number of daily steps significantly increased, whereas the amount of physical activity increased but was not significant. The mean decrease (±SD) in HbA1c levels after 3 and 6 months was estimated to be -0.40% (±0.45, p<0.0001) and -0.19% (±0.55, p=0.033), respectively, by a linear mixed model that included baseline HbA1c levels and age as covariates. The program failed to improve the body mass index and blood pressure of the participants. The percentage of active stage (action and maintenance stage) in stage of health behavior significantly increased from 48% to 68% (p=0.011). Conclusion Intensive lifestyle intervention using a wearable monitoring system and remote health guidance improved diabetic control in middle-aged company workers.

Keywords: exercise; healthy behavior; internet of things; lifestyle change; type 2 diabetes mellitus.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
An overview of the “MY PAGE” system.
Figure 2.
Figure 2.
The monthly number of daily steps and physical activity scores. Daily steps were measured by activity meters worn on the wrist. Black bars show the average number of daily steps. Physical activity scores were calculated using our original formula from data uploaded by the same activity meter. Striped bars show the average weekly physical activity scores. *p<0.05 from baseline (August) to each time point, as determined by a paired t-test.
Figure 3.
Figure 3.
Changes in serum glycated hemoglobin (HbA1c) levels from baseline to 3 and 6 months. The HbA1c levels significantly deceased in the subjects enrolled in this exercise intervention program. This exercise program was effective for improving diabetic control. *p<0.05 from baseline to each time point, as calculated by a linear mixed model.
Figure 4.
Figure 4.
Comparison of the changes in glycated hemoglobin (HbA1c) levels, body mass index and blood pressure between subjects in the exercise program and the nonrandomized controls. The controls were selected from the same pool of company workers who took the annual health check in the same season (month) and who were matched according to their HbA1c levels. This analysis was performed to verify that the decrease in the HbA1c levels of the active subjects was not an artefact of seasonal fluctuation. *p<0.05 between study subjects and controls, as determined by an ANOVA. ANOVA: analysis of variance
Figure 5.
Figure 5.
Changes in stage of health behavior with respect to regular physical exercise, healthy dietary habits, and smoking cessation. Stages of health behavior with respect to regular physical exercise and heathy dietary habits were significantly improved by the exercise intervention program. *p<0.05 between baseline and the end of this program, as determined by a Wilcoxon rank-sum test.
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