Facilitating Improvements in Kidney Health Using a Smartphone App Counseling Program in Patients With Diabetes

Geisinger Clinic50 enrolled

Overview

This pilot study tests the feasibility of dietary app-supported tele-counseling in the treatment of patients with stage 1-3a chronic kidney disease (CKD) and diabetes.

Patients with diabetes and stage 1-3a CKD receive instructions on downloading and using MyFitnessPal on their smartphone or computer to log meal data daily, weekly website educational materials, and weekly telephone visits with a dietician for 8 weeks. Patients receive a follow-up phone call from the dietitian and 5 and 11 months for further support and counseling, and are also invited to attend a local dietitian-led grocery tour. This pilot study examines the feasibility of dietary app-supported tele-counseling in the treatment of patients with stage 1-3a chronic kidney disease (CKD) and diabetes. Main outcomes include sodium intake assessed by 24 hour urine collection as well as other dietary measures related to kidney disease (sodium/potassium ratio, Healthy Eating Index score, 24-hour urine phosphorus, estimated net endogenous acid production) and health measures (24-hour ambulatory blood pressure, weight, albumin/creatinine ratio)

Study Type

INTERVENTIONAL

Allocation

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

Conditions

Chronic Kidney Disease Diabetes Mellitus Albuminuria

Interventions

Remote counselingBEHAVIORAL

For an 8 week period, patients will be asked to enter dietary information into the MyFitnessPal mobile application or website. Dietitians will access this information and provide personalized motivational interview phone calls on a weekly basis. After the initial 8 weeks, patients will receive a dietitian follow-up phone call around 5 and 11 months later.

Eligibility

Sex: ALLMin age: 21 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age \> 21 years * Diabetes diagnosis (Type I or Type II) * Last urine albumin/creatinine ratio (ACR) within the past two years \> 30 mg/g * Last outpatient estimated glomerular filtration rate (eGFR) within the past year \> 45 ml/min/1.73m2 * Last outpatient systolic blood pressure (SBP) within the past year \< 160 mmHg * Last outpatient diastolic blood pressure (DBP) within the past year \<100 mmHg * Preceding eGFR decline rate less than -2 ml/min/1.73m2/y * At least 2 outpatient eGFR measurements in electronic health record, separated by at least 2 years * Agreeable to change diet (decrease sodium and red/processed meat intake, increase fruit and vegetable intake) * Access to smartphone or computer Exclusion Criteria: * Inability to understand English * Myocardial infarction, stroke, or atherosclerotic cardiovascular disease procedure within 6 months. * Current treatment for malignancy * Planned bariatric surgery * Pregnancy or planning to become pregnant within next 2 years * Self-reported average consumption of \> 14 alcoholic beverages per week * Psychiatric hospitalization in past year * Unstable angina * Urine ACR \> 2500 mg/g * Last potassium \> 5.0 mg/dL * Hypoglycemia episode in past 1 month (glucose \< 70 mg/dL) * Principal investigator discretion (i.e. concerns about safety, compliance)

Locations (2)

Geisinger Medical Center

Danville, Pennsylvania, United States

Geisinger Wyoming Valley Medical Center

Wilkes-Barre, Pennsylvania, United States