MON-266 Mobile Health Intervention for Patients with Type 2 Diabetes: Relationship of Health Literacy, Social Determinants, and Clinical Outcomes

Abstract S.M. Wilson: None. A.A. Berlot: None. V. Kim: None. S. Jariwala: None. Introduction: Type 2 Diabetes Mellitus (T2DM) is the leading cause of renal failure, lower limb amputation, and adult-onset blindness. Lower-income and marginalized groups are disproportionately affected by health disparities, including low health literacy, that impact care received for T2DM and other chronic conditions. Smartphone applications (apps) are widely used to aid in chronic disease management and improve patients’ health outcomes, particularly in regions with limited healthcare accessibility. However, the impact of health literacy on mobile health interventions and subsequent clinical outcomes is often unexplored. In this study, we explored whether health literacy impacted diabetes outcomes using DiabetesXcel, an educational video-based app previously found to be effective in improving diabetes-related outcomes. Methods: The DiabetesXcel mobile app was piloted in a single-arm trial among adults with T2DM living in the Bronx, NY. Baseline health literacy, measured by the Newest Vital Sign (NVS) tool, was analyzed for its association with user engagement and T2DM-related outcomes at 4- and 6-months among DiabetesXcel users. The primary outcome was the number of monthly logins and in-app questions answered (including post-chapter quizzes and timed push notifications). Secondary outcomes included the change in diabetes management-related clinical outcomes, via questionnaires, and the change in hemoglobin A1c and LDL cholesterol. All models were adjusted a priori for age, gender, race/ethnicity, education level, insulin use, and insurance type. Results: The sample’s baseline NVS score, on a scale from 1-6, was 4.33 ± 1.25. At baseline (N=46), those with greater health literacy (NVS >4) had higher educational attainment than those with less health literacy (NVS <4) (p<0.01). While, in unadjusted models, every one-point improvement in NVS was associated with a 43% lower odds of answering a higher-than-average number of in-app questions at 6 months (OR=0.57, [95% CI 0.33, 0.99], p=0.046), this did not persist with adjustment (OR=0.68, [95% CI 0.24, 1.97], p=0.48). In unadjusted models, for every one point greater NVS score, there was a 0.24 point change in A1c from baseline to 4 months (beta=0.24, [95% CI 0.06, 0.41], p<0.01), though this relationship did not persist at 6 months (beta=0.22, [95% CI -0.01, 0.44], p=0.06) nor with further adjustment. In adjusted models, for every one point greater NVS score, there was a 9.54 point decrease in self-efficacy from baseline to 6 months (beta=-9.54, [95% CI -15.59, -3.49], p<0.01). Conclusion: Health literacy, measured by NVS, is associated with higher educational attainment and less app usage among DiabetesXcel users. Our data supports the notion that DiabetesXcel benefits users regardless of health literacy level. Future steps include analyzing changes in health literacy through app use and refining app design and offerings. Monday, June 3, 2024