{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:43:39Z","timestamp":1785545019093,"version":"3.56.0"},"reference-count":21,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Type 2 diabetes mellitus (T2DM) requires sustained self-management and lifestyle modification to achieve optimal glycemic control. Hybrid care models that combine digital health technologies with in-person clinical support may enhance patient engagement while improving the accessibility and scalability of diabetes care. However, evidence regarding their effectiveness and feasibility in Southeast Asian populations remains limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n This study aimed to evaluate the preliminary effectiveness and feasibility of a national hybrid digital intervention for individuals with T2DM in Brunei Darussalam. The primary objective was to evaluate the proportion of participants achieving a reduction in glycated hemoglobin (HbA\n 1c<\/jats:sub>\n ) of \u22650.6% after 16 weeks. Secondary objectives included evaluating changes in metabolic parameters, anthropometric outcomes, and health-related quality of life (QoL).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This single-arm, nonrandomized pilot trial enrolled adults with T2DM into a 16-week hybrid digital intervention integrating remote health coaching, structured digital education, self-monitoring activities, and asynchronous communication via WhatsApp. Participants attended scheduled video consultations (VCs) and submitted self-monitoring records throughout the intervention period. Clinical outcomes included changes in HbA\n 1c<\/jats:sub>\n , fasting blood glucose, lipid profile parameters, BMI, waist circumference, and QoL measured using the EQ-5D-5L instrument. Feasibility outcomes included intervention completion, VC attendance, participant engagement, and intervention acceptability.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 122 participants were enrolled, and 108 (88.5%) completed the intervention. Among 104 participants with complete HbA\n 1c<\/jats:sub>\n data, there was a mean reduction of 1.2% (95% CI \u22121.45 to \u22120.96;\n P<\/jats:italic>\n <.001). Overall, 65.4% (68\/104) of participants achieved the predefined HbA\n 1c<\/jats:sub>\n reduction threshold of \u22650.6%, while 84.6% (88\/104) demonstrated an overall reduction in HbA\n 1c<\/jats:sub>\n . Significant improvements were also observed in fasting blood glucose (\u22121.7 mmol\/L, 95% CI \u22122.3 to \u22121.2;\n P<\/jats:italic>\n <.001), BMI (\u22120.4 kg\/m\u00b2, 95% CI \u22120.6 to \u22120.2;\n P<\/jats:italic>\n <.001), waist circumference (\u22121.9 cm, 95% CI \u22122.9 to \u22120.9;\n P<\/jats:italic>\n <.001), total cholesterol (\u22120.3 mmol\/L, 95% CI \u22120.6 to \u22120.2;\n P<\/jats:italic>\n <.001), triglycerides (\u22120.5 mmol\/L, 95% CI \u22120.7 to \u22120.2;\n P<\/jats:italic>\n <.001), and EuroQol Visual Analog Scale (EQ-VAS) scores (+6.7 points, 95% CI 3.9 to 9.6;\n P<\/jats:italic>\n <.001). The intervention demonstrated favorable feasibility outcomes, including an 88.5% (108\/122) completion rate, attendance at \u22655 VCs by 75.9% (82\/108) of participants, and high participant satisfaction, with 86.9% (86\/99) of respondents reporting satisfaction or extreme satisfaction with the intervention.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The pilot trial demonstrated the acceptability, preliminary effectiveness, and feasibility of a national hybrid digital intervention for individuals with T2DM in Brunei Darussalam. High completion rates, sustained participant engagement, and positive participant feedback support the practicality of implementation within a national digital health ecosystem. The intervention was also associated with improvements in glycemic control, metabolic outcomes, anthropometric measures, and health-related QoL. Larger controlled studies are warranted to evaluate long-term effectiveness, scalability, and implementation outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/94551","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T14:00:09Z","timestamp":1781791209000},"page":"e94551-e94551","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the Impact and Practicality of a National Digital Intervention for Type 2 Diabetes Mellitus: Single-Arm Nonrandomized Pilot Trial"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4088-5619","authenticated-orcid":false,"given":"Alice Moi Ling","family":"Yong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4479-7288","authenticated-orcid":false,"given":"Hiu Nam","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7747-4162","authenticated-orcid":false,"given":"Pui Lin","family":"Chong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8023-5357","authenticated-orcid":false,"given":"Chee Kwang","family":"Yung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5395-0005","authenticated-orcid":false,"given":"Musjarena","family":"Mulok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3102-0087","authenticated-orcid":false,"given":"Syuhrah","family":"Musa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2368-8915","authenticated-orcid":false,"given":"Si Yee","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8892-3834","authenticated-orcid":false,"given":"Yvonne","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6014-0519","authenticated-orcid":false,"given":"Athirah","family":"Yusof","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6163-2445","authenticated-orcid":false,"given":"Yufan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7809-3492","authenticated-orcid":false,"given":"Hong Shen","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"issue":"2","key":"R1","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1038\/nrendo.2017.151","article-title":"Global aetiology and epidemiology of type 2 diabetes mellitus and its complications","volume":"14","author":"Zheng","journal-title":"Nat Rev Endocrinol"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","journal-title":"Diabetes Res Clin Pract"},{"issue":"6","key":"R3","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1056\/NEJMoa012512","article-title":"Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin","volume":"346","author":"Knowler","journal-title":"N Engl J Med"},{"issue":"10120","key":"R4","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/S0140-6736(17)33102-1","article-title":"Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial","volume":"391","author":"Lean","journal-title":"Lancet"},{"issue":"5","key":"R5","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.2337\/dc07-1845","article-title":"Where is the patient in diabetes performance measures? 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