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Title: A mobile app for identifying individuals with undiagnosed diabetes and prediabetes and for promoting behavior change : 2-year prospective study
Authors: Leung, AYM 
Xu, XY 
Chau, PH
Cheung, MKT
Wong, CKH
Fong, DYT
Wong, JYH
Lam, CLK
Keywords: Diabetes mellitus
Prediabetic state
Mobile apps
Issue Date: 2018
Publisher: JMIR Publications, Inc.
Source: JMIR mHealth and uHealth, May 2018, v. 6, no. 5, e10662, p. 1-10 How to cite?
Journal: JMIR mHealth and uHealth 
Abstract: Background: To decrease the burden of diabetes in society, early screening of undiagnosed diabetes and prediabetes is needed. Integrating a diabetes risk score into a mobile app would provide a useful platform to enable people to self-assess their risk of diabetes with ease.
Objective: The objectives of this study were to (1) assess the profile of Diabetes Risk Score mobile app users, (2) determine the optimal cutoff value of the Finnish Diabetes Risk Score to identify undiagnosed diabetes and prediabetes in the Chinese population, (3) estimate users' chance of developing diabetes within 2 years of using the app, and (4) investigate high-risk app users' lifestyle behavior changes after ascertaining their risk level from the app.
Methods: We conducted this 2-phase study among adults via mobile app and online survey from August 2014 to December 2016. Phase 1 adopted a cross-sectional design, with a descriptive analysis of the app users' profile. We used a Cohen kappa score to show the agreement between the risk level (as shown in the app) and glycated hemoglobin test results. We used sensitivity, specificity, and area under the curve to determine the optimal cutoff value of the diabetes risk score in this population. Phase 2 was a prospective cohort study. We used a logistic regression model to estimate the chance of developing diabetes after using the app. Paired t tests compared high-risk app users' lifestyle changes.
Results: A total of 13,289 people used the app in phase 1a. After data cleaning, we considered 4549 of these as valid data. Most users were male, and 1811 (39.81%) had tertiary education or above. Among them, 188 (10.4%) users agreed to attend the health assessment in phase 1b. We recommend the optimal value of the diabetes risk score for identifying persons with undiagnosed diabetes and prediabetes to be 9, with an area under the receiver operating characteristic curve of 0.67 (95% CI 0.60-0.74), sensitivity of 0.70 (95% CI 0.58-0.80), and specificity of 0.57 (95% CI 0.47-0.66). At the 2-year follow-up, people in the high-risk group had a higher chance of developing diabetes (odds ratio 4.59, P=.048) than the low-risk group. The high-risk app users improved their daily intake of vegetables (baseline: mean 0.76, SD 0.43; follow-up: mean 0.93, SD 0.26; t(81)=-3.77, P<.001) and daily exercise (baseline: mean 0.40, SD 0.49; follow-up: mean 0.54, SD 0.50; t(81)=-2.08, P=.04).
Conclusions: The Diabetes Risk Score app has been shown to be a feasible and reliable tool to identify persons with undiagnosed diabetes and prediabetes and to predict diabetes incidence in 2 years. The app can also encourage high-risk people to modify dietary habits and reduce sedentary lifestyle.
EISSN: 2291-5222
DOI: 10.2196/10662
Rights: ©Angela YM Leung, Xin Yi Xu, Pui Hing Chau, Yee Tak Esther Yu, Mike KT Cheung, Carlos KH Wong, Daniel YT Fong, Janet YH Wong, Cindy LK Lam. Originally published in JMIR Mhealth and Uhealth (, 24.05.2018. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
The following publication Leung, A. Y. M., Xu, X. Y., Chau, P. H., Yu, Y. T. E., Cheung, M. K. T., Wong, C. K. H., . . . Lam, C. L. K. (2018). A mobile app for identifying individuals with undiagnosed diabetes and prediabetes and for promoting behavior change: 2-year prospective study. Journal of Medical Internet Research, 20(5), e10662, 1-10 is available at
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