Apps and Peer support for a Healthy future and Living Well with Diabetes – Non-Mental Health

1-Patients with diabetes and without a mental health (MH) condition will receive a phone application - an “App” containing diabetes and mental health resources. The adapted App was configured in collaboration with a digital health company (Perx Health) using an existing clinically validated digital health platform used for several conditions (eg Type 2 diabetes, cystic fibrosis). A working group of diabetes (eg credentialled diabetes educators endocrinologists) and MH (eg psychiatric and psychologist) clinicians, academics, digital health company (Perx Health) members, consumers and patient group representatives was established. A list of diabetes and MH resources and website links were identified and agreed upon using a Delphi process. The adapted Perx App constitutes the intervention and has been configured with two Health Hubs; one for participants with Type 1 diabetes and the other for those with Type 2 diabetes. The online written diabetes resources in both health hubs are available as hyperlinks within the subject headings: Glucose Management, Insulin Pumps, Injections, Sick Days, Food, Contraception and Pre-pregnancy and Living with Diabetes. Similarly, the online mental health resources are available as hyperlinks within the subject headings: Mindfulness Apps and Online Resources, Anxiety, Depression, Stress, Eating Disorders and General Mental Health. Diabetes and Mental health in the Health Hub will be available for participants to access ad libitum during the six month intervention period. Participants will also receive in-app communications every four to five days (on average) in the form of messages, alerts and tasks which will direct them to specific resources within the health hub. App analytics will be collected by Perx and include: medication and task adherence, enrolment, App utilisation (eg average sessions per day, average time spent in app per month, utilisation of diabetes and mental health resources), participant satisfaction and content engagement. Time using the app is linked to the in-app communication and is an exploratory outcome. 2-Diabetes management involves standard management through local diabetes services. Appointments lasting approximately 60 minutes are scheduled for patients to attend diabetes clinics every three months. During clinic appointments patients’ diabetes management is assessed and revised according to that assessment by both a credentialled diabetes educator and an endocrinologist. HbA1c and weight are generally measured every 3 months as part of clinical care by either point of care or laboratory-based methods. Attendance is recorded electronically. All participants receiving the intervention (App) will have access to standard diabetes care through their regular clinic. This includes education sessions, food diary, self-management including blood glucose monitoring, healthy eating, regular clinic attendance with review of blood glucose monitoring and weight: these are performed by either or both the educator and/or endocrinologist. All participants will have access to Peer Support which is facilitated by patients with lived experience of diabetes and can be either through digital means (eg ad hoc Facebook communication, Zoom meetings) or 1:1 or group face-to-face meetings. Frequency and duration is as decided by the peers/peer support facilitators. All participants will receive an activity tracker. There are no differences in this intervention compared to the intervention delivered to the mental health arm.