A Nurse-Led Digital Coaching Program to Improve Blood Sugar Control in Adults With Type 2 Diabetes

The goal of this clinical trial is to learn whether ChronoCoach, a nurse-led multidisciplinary digital coaching program, improves blood sugar control and self-management in adults with type 2 diabetes attending primary health care diabetes services in Bahrain. The main question it aims to answer is: Does ChronoCoach plus usual care lower HbA1c more than usual care alone after 3 months? Researchers will also compare diabetes self-care, self-efficacy, family involvement, quality of life and satisfaction, and will explore feasibility and acceptability. Participants will be randomly assigned to ChronoCoach or usual care. ChronoCoach participants will use a smartphone app for 3 months to record blood glucose, medicines, symptoms, food and activity, and will receive structured coaching from a diabetes nurse with pharmacy, nutrition, exercise, psychological and physician input when needed. All participants continue usual care and complete HbA1c testing and questionnaires at baseline, 3 months and 6 months. Research hypothesis: \* Participants allocated to ChronoCoach will have a greater reduction in HbA1c than participants receiving usual care, after adjusting for baseline HbA1c.

Inclusion Criteria: * Adults aged 18 years or older * Clinical diagnosis of type 2 diabetes mellitus for at least 1 year * Most recent HbA1c of 7.0% or higher within the previous 3 months * Receiving outpatient diabetes care at a participating primary health care centre * Owns or has regular access to a compatible smartphone and is able to use the ChronoCoach app, independently or with support from a family member * Able to communicate in Arabic or English * Able to provide written informed consent and attend follow-up at 3 and 6 months Exclusion Criteria: * Acute or unstable clinical condition requiring urgent or inpatient management at recruitment * Clinical, cognitive or psychiatric impairment preventing informed consent or safe participation in the digital intervention * Unable to use the digital platform despite reasonable training and support * Current participation in another intervention study likely to influence glycemic control or diabetes self-management * Participation in the ChronoCoach pilot (usability) phase * Pregnancy or planning pregnancy during the study period