J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Short Communication

Volume 13, Number 8, August 2021, pages 425-433

A Pilot Study of Intervention With a Mobile Application Visualizing the Macronutrient Content for Type 2 Diabetes at a Japanese Center

Figure 1. Sample app screenshots (translated into English). When eating one bowl of white rice, the participant searched for the word “Rice” and then selected the closest match from the presented list, including the amount they ate (a). After logging all meals of the day, the home screen displayed the total daily intake of energy and various nutrients. If the participant exceeded the recommended amount of any of these, the corresponding line would turn red (b). BW: body weight; Pro: protein; Carbo: carbohydrate; app: application.

Figure 2. (a) Scatter plot of ΔHbA1c, ΔGA and Δcarbohydrate by app. (b) Scatter plot of ΔBMI, ΔBW, Δenergy and Δcarbohydrate by app. HbA1c: hemoglobin A1c; GA: glycated albumin; BMI: body mass index; BW: body weight; app: application.

**Table 1.** Reliability and Validity of Estimates by the “Calomeal” App, Compared to the Estimates of a Registered Dietitian
	ICC (2, 36) (95% CI)	Bland-Altman analysis
An ICC over 0.81 indicates high reliability. ICC: intraclass correlation coefficient; app: application; CI: confidence interval.
Energy	0.94 (0.89 - 0.97)	-268.0 - 306.9	R = 0.12	P = 0.64	None
Protein	0.92 (0.83 - 0.96)	-0.6 - 1.4	R = 0.01	P = 0.99	None
Lipid	0.88 (0.76 - 0.94)	-0.8 - 1.7	R = 0.03	P = 0.85	None
Carbohydrate	0.95 (0.90 - 0.97)	-44.4 - 36.7	R = 0.12	P = 0.36	None
Fiber	0.82 (0.65 - 0.91)	-0.2 - 1.5	R = -0.06	P = 0.74	None
Salt	0.84 (0.67 - 0.92)	-3.5 - 2.0	R = -0.19	P = 0.26	None

Table 1. Reliability and Validity of Estimates by the “Calomeal” App, Compared to the Estimates of a Registered Dietitian

ICC (2, 36) (95% CI)

Bland-Altman analysis

Fixed bias

Proportional bias

95% CI (%)

Test of no correlation

Bias

An ICC over 0.81 indicates high reliability. ICC: intraclass correlation coefficient; app: application; CI: confidence interval.

Energy

0.94 (0.89 - 0.97)

-268.0 - 306.9

R = 0.12

P = 0.64

None

Protein

0.92 (0.83 - 0.96)

-0.6 - 1.4

R = 0.01

P = 0.99

None

Lipid

0.88 (0.76 - 0.94)

-0.8 - 1.7

R = 0.03

P = 0.85

None

Carbohydrate

0.95 (0.90 - 0.97)

-44.4 - 36.7

R = 0.12

P = 0.36

None

Fiber

0.82 (0.65 - 0.91)

-0.2 - 1.5

R = -0.06

P = 0.74

None

Salt

0.84 (0.67 - 0.92)

-3.5 - 2.0

R = -0.19

P = 0.26

None

**Table 2.** Data at Baseline and at the End of the Study (3 months After Baseline)
	Baseline	3 months	P value
Total n = 18. Data are expressed as means ± SD for normally distributed data and medians (interquartile range) for data with skewed distributions. *A P value < 0.05 denotes the presence of a statistically significant difference. HbA1c: hemoglobin A1c; GA: glycated albumin; BW: body weight; BMI: body mass index; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; DTSQ: diabetes treatment satisfaction questionnaire; PAID: problem areas in diabetes; BP: blood pressure; app: application.
HbA1c (%)	7.9 (7.58 - 8.23)	7.6 (7.3 - 8.23)	0.0410*
GA (%)	18.9 (17.9 - 20.1)	18.75 (17.025 - 9.825)	0.0032*
BW (kg)	68.3 (56.95 - 81.88)	66.1 (55.45 - 79.63)	0.0044*
BMI (kg/m²)	25.17 (21.63 - 28.59)	24.54 (21.57 - 27.81)	0.0057*
LDL-C (mg/dL)	100 (79.25 - 132.75)	99 (77.75 - 138.75)	0.7220
HDL-C (mg/dL)	54 (42.5 - 60.5)	57.5 (40.75 - 65.75)	0.0532
Triglycerides (mg/dL)	126 (90.25 - 289.75)	154 (77.75 - 268.75)	0.7281
Glucose (mg/dL)	147 (132 - 163.75)	149.5 (128.25 - 181.25)	0.6650
Urinary albumin (mg/gCre)	8.5 (6.75 - 13.25)	8 (3.75 - 24.5)	0.1359
DTSQ	20 (18 - 24)	21 (18 - 24.5)	0.1063
PAID	40 (27.5 - 51.56)	33.75 (16.88 - 52.5)	0.1361
Systolic BP (mm Hg)	129.5 (112 - 140.25)	125.5 (115.5 - 145.75)	0.7060
Energy by app (kcal/day)	1,998.5 (1,754.25 - 2,407.75)	1,991 (1,752.75 - 2,154)	0.1068
Energy by dietician (kcal/day)	1,884 (1,762.5 - 2,314.5)	2,122.5 (1,664 - 2,276)	0.4020
Protein by app (g/day)	69.35 (63.25 - 82.3)	70 (59.78 - 83.98)	0.9753
Protein by dietician (g/day)	71.05 (66.1 - 80.55)	69.05 (59.5 - 90.38)	0.7662
Lipid by app (g/day)	75.8 (65.15 - 96.25)	73.55 (62.55 - 86.38)	0.2067
Lipid by dietician (g/day)	72.45 (63.03 - 85.3)	72.85 (57.93 - 90.93)	0.9736
Carbohydrate by app (g/day)	238.1 (213.35 - 301.75)	237.6 (209.68 - 277.35)	0.1941
Carbohydrate by dietician (g/day)	247.3 (199.73 - 297.95)	240.9 (192.25 - 281.08)	0.2295
Fiber by app (g/day)	12 (9.4 - 19.3)	13.35 (10.03 - 20.43)	0.7346
Fiber by dietician (g/day)	12.5 (10.08 - 18)	13.6 (9.28 - 17.2)	0.2174
Salt by app (g/day)	11 (9.48 - 12.48)	10.25 (8.4 - 14.48)	0.9864
Salt by dietician (g/day)	10.75 (9.48 - 11.68)	10.65 (8.38 - 11.95)	0.3303

Table 2. Data at Baseline and at the End of the Study (3 months After Baseline)

Baseline

3 months

P value

Total n = 18. Data are expressed as means ± SD for normally distributed data and medians (interquartile range) for data with skewed distributions. *A P value < 0.05 denotes the presence of a statistically significant difference. HbA1c: hemoglobin A1c; GA: glycated albumin; BW: body weight; BMI: body mass index; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; DTSQ: diabetes treatment satisfaction questionnaire; PAID: problem areas in diabetes; BP: blood pressure; app: application.

HbA1c (%)

7.9 (7.58 - 8.23)

7.6 (7.3 - 8.23)

0.0410*

GA (%)

18.9 (17.9 - 20.1)

18.75 (17.025 - 9.825)

0.0032*

BW (kg)

68.3 (56.95 - 81.88)

66.1 (55.45 - 79.63)

0.0044*

BMI (kg/m²)

25.17 (21.63 - 28.59)

24.54 (21.57 - 27.81)

0.0057*

LDL-C (mg/dL)

100 (79.25 - 132.75)

99 (77.75 - 138.75)

0.7220

HDL-C (mg/dL)

54 (42.5 - 60.5)

57.5 (40.75 - 65.75)

0.0532

Triglycerides (mg/dL)

126 (90.25 - 289.75)

154 (77.75 - 268.75)

0.7281

Glucose (mg/dL)

147 (132 - 163.75)

149.5 (128.25 - 181.25)

0.6650

Urinary albumin (mg/gCre)

8.5 (6.75 - 13.25)

8 (3.75 - 24.5)

0.1359

DTSQ

20 (18 - 24)

21 (18 - 24.5)

0.1063

PAID

40 (27.5 - 51.56)

33.75 (16.88 - 52.5)

0.1361

Systolic BP (mm Hg)

129.5 (112 - 140.25)

125.5 (115.5 - 145.75)

0.7060

Energy by app (kcal/day)

1,998.5 (1,754.25 - 2,407.75)

1,991 (1,752.75 - 2,154)

0.1068

Energy by dietician (kcal/day)

1,884 (1,762.5 - 2,314.5)

2,122.5 (1,664 - 2,276)

0.4020

Protein by app (g/day)

69.35 (63.25 - 82.3)

70 (59.78 - 83.98)

0.9753

Protein by dietician (g/day)

71.05 (66.1 - 80.55)

69.05 (59.5 - 90.38)

0.7662

Lipid by app (g/day)

75.8 (65.15 - 96.25)

73.55 (62.55 - 86.38)

0.2067

Lipid by dietician (g/day)

72.45 (63.03 - 85.3)

72.85 (57.93 - 90.93)

0.9736

Carbohydrate by app (g/day)

238.1 (213.35 - 301.75)

237.6 (209.68 - 277.35)

0.1941

Carbohydrate by dietician (g/day)

247.3 (199.73 - 297.95)

240.9 (192.25 - 281.08)

0.2295

Fiber by app (g/day)

12 (9.4 - 19.3)

13.35 (10.03 - 20.43)

0.7346

Fiber by dietician (g/day)

12.5 (10.08 - 18)

13.6 (9.28 - 17.2)

0.2174

Salt by app (g/day)

11 (9.48 - 12.48)

10.25 (8.4 - 14.48)

0.9864

Salt by dietician (g/day)

10.75 (9.48 - 11.68)

10.65 (8.38 - 11.95)

0.3303

**Table 3.** Correlations of ΔHbA1c and ΔBMI With Other Clinical Parameters Over the 3-Month Study Period
Variable 1	Variable 2	R_S	P
*A P value < 0.05 denotes the presence of a statistically significant difference. HbA1c: hemoglobin A1c; GA: glycated albumin; BMI: body mass index; DTSQ: diabetes treatment satisfaction questionnaire; PAID: problem areas in diabetes; app: application.
ΔHbA1c	Age	0.3255	0.1874
	Duration	-0.0600	0.8132
	Δbody weight	0.0016	0.9951
	ΔBMI	0.0354	0.8891
	ΔGA	0.4779	0.0449*
	Δenergy by app	0.2297	0.3592
	Δprotein by app	-0.0818	0.7470
	Δlipidby app	-0.0198	0.9379
	Δcarbohydrate by app	0.5018	0.0338*
	Δenergy by dietician	0.1478	0.5582
	Δprotein by dietician	0.0026	0.9918
	Δlipid by dietician	0.0541	0.8310
	Δcarbohydrate by dietician	0.3915	0.1082
	ΔDTSQ	0.1139	0.6527
	ΔPAID	0.2075	0.4087
ΔBMI	Age	0.4078	0.0929
	Duration	0.3473	0.1579
	Δbody weight	0.9907	< 0.0001*
	ΔHbA1c	0.0354	0.8891
	ΔGA	0.1281	0.6125
	Δenergy by app	0.4894	0.0393*
	Δprotein by app	0.2623	0.2931
	Δlipidby app	0.1785	0.4784
	Δcarbohydrate by app	0.5542	0.0170*
	Δenergy by dietician	0.1187	0.6390
	Δprotein by dietician	-0.0774	0.7600
	Δlipid by dietician	0.2157	0.0390
	Δcarbohydrate by dietician	0.0506	0.8421
	ΔDTSQ	-0.3559	0.1472
	ΔPAID	-0.1592	0.5281

Table 3. Correlations of ΔHbA1c and ΔBMI With Other Clinical Parameters Over the 3-Month Study Period

Variable 1

Variable 2

R_S

*A P value < 0.05 denotes the presence of a statistically significant difference. HbA1c: hemoglobin A1c; GA: glycated albumin; BMI: body mass index; DTSQ: diabetes treatment satisfaction questionnaire; PAID: problem areas in diabetes; app: application.

ΔHbA1c

Age

0.3255

0.1874

Duration

-0.0600

0.8132

Δbody weight

0.0016

0.9951

ΔBMI

0.0354

0.8891

ΔGA

0.4779

0.0449*

Δenergy by app

0.2297

0.3592

Δprotein by app

-0.0818

0.7470

Δlipidby app

-0.0198

0.9379

Δcarbohydrate by app

0.5018

0.0338*

Δenergy by dietician

0.1478

0.5582

Δprotein by dietician

0.0026

0.9918

Δlipid by dietician

0.0541

0.8310

Δcarbohydrate by dietician

0.3915

0.1082

ΔDTSQ

0.1139

0.6527

ΔPAID

0.2075

0.4087

ΔBMI

Age

0.4078

0.0929

Duration

0.3473

0.1579

Δbody weight

0.9907

< 0.0001*

ΔHbA1c

0.0354

0.8891

ΔGA

0.1281

0.6125

Δenergy by app

0.4894

0.0393*

Δprotein by app

0.2623

0.2931

Δlipidby app

0.1785

0.4784

Δcarbohydrate by app

0.5542

0.0170*

Δenergy by dietician

0.1187

0.6390

Δprotein by dietician

-0.0774

0.7600

Δlipid by dietician

0.2157

0.0390

Δcarbohydrate by dietician

0.0506

0.8421

ΔDTSQ

-0.3559

0.1472

ΔPAID

-0.1592

0.5281