Journal Article

mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED): statistical analysis plan

Vetrovsky, Tomas, Elavsky, Steriani, Van Dyck, Delfien, Jurkova, Katerina, Wahlich, Charlotte, Malisova, Katerina, Dygryn, Jan, Yates, Tom, Maes, Iris, Capek, Vaclav, Seifert, Bohumil, Pelclova, Jana, Cimler, Richard, Ussher, Michael, Pfeiferova, Marketa, Harris, Tess, Steffl, Michal, Rowlands, Alex, Kral, Norbert, Kuhnova, Jitka

2025

Overview

Background Type 2 diabetes and prediabetes represent significant global health challenges, with physical activity (PA) being essential for disease management and prevention. Despite the well-documented benefits, many individuals with (pre)diabetes remain insufficiently active. General practitioners (GP) provide an accessible platform for delivering interventions; however, integrating PA interventions into routine care is hindered by resource constraints. Objectives The ENERGISED trial aims to address these barriers through an innovative GP-initiated mHealth intervention combining wearable technology and just-in-time adaptive interventions. Methods The ENERGISED trial is a pragmatic, 12-month, multicentre, randomised controlled trial, assessing a GP-initiated mHealth intervention to increase PA and reduce sedentary behaviour in patients with type 2 diabetes and prediabetes. The primary outcome is daily step count, assessed via wrist-worn accelerometry. The primary analysis follows the intention-to-treat principle, using mixed models for repeated measures. Missing data will be handled under the missing-at-random assumption, with sensitivity analyses exploring robustness through reference-based multiple imputation. The trial incorporates the estimand framework to provide transparent and structured treatment effect estimation. Discussion This statistical analysis plan outlines a robust approach to addressing participant non-adherence, protocol violations, and missing data. By adopting the estimand framework and pre-specified sensitivity analyses, the plan ensures methodological rigour while enhancing the interpretability and applicability of results. Conclusions The ENERGISED trial leverages innovative mHealth strategies within primary care to promote PA in individuals with (pre)diabetes. The pre-specified statistical framework provides a comprehensive guide for analysing trial data and contributes to advancing best practices in behavioural intervention trials for public health. Trial registration ClinicalTrials.gov NCT05351359 . Registered on April 28, 2022.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Accelerometry / Analysis / Automation / Biomedicine / Cellular telephones / Counseling / Diabetes / Diabetes Mellitus, Type 2 - diagnosis / Diabetes Mellitus, Type 2 - psychology / Diabetes Mellitus, Type 2 - therapy / Estimand framework / Exercise / Family medicine / Fitbit / Fitness Trackers / General Practice - methods / GGIR / Glucose / Health Sciences / Humans / Intervention / Just-in-time adaptive intervention (JITAI) / Medicine / Medicine & Public Health / Multicenter Studies as Topic / Patients / Physical fitness / Physicians (General practice) / Plasma / Pragmatic Clinical Trials as Topic / Pragmatic trial / Prediabetic state / Prediabetic State - diagnosis / Prediabetic State - psychology / Prediabetic State - therapy / Primary care / Sedentary Behavior / Statistical analysis / Statistics for Life Sciences / Telemedicine / Telemedicine - statistics & numerical data / Text messaging / Type 2 diabetes / Update / Wearable Electronic Devices / Wearables