Previously submitted to: JMIR Diabetes (no longer under consideration since Nov 12, 2021)
Date Submitted: Mar 10, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Outcomes of a smart-phone delivered diabetes prevention program for patients with prediabetes: 1-year real-world service evaluation
ABSTRACT
Background:
Prediabetes is the state of elevated blood glucose levels with glycaemic parameters above normal but below the (type 2) diabetes threshold. Prediabetes is considered a state of high risk for developing type 2 diabetes with yearly transition rate of 5%-10% to type 2 diabetes. There are almost 86 million adults with prediabetes in the United States alone. The world-wide prevalence of impaired glucose tolerance (IGT; a parameter of prediabetes) in 2010 was estimated to be 343 million (7.8%). Prediabetes is a global burden, with the International Diabetes Federation projecting an increase in prevalence of prediabetes to 471 million globally by 2035.
Objective:
Our objective was to evaluate the 1-year outcomes of the smart-phone delivered Low Carb Program for Prediabetes, a nutritionally focused, 12-session educational intervention for glycaemic control and weight loss for adults with prediabetes (i.e. a type 2 diabetes prevention program). The program reinforces carbohydrate restriction using behavioural techniques including goal setting, peer support, and behavioural self-monitoring.
Methods:
The study used a quasi-experimental research design comprised of an open-label, single-arm, pre-post intervention using a sample of convenience. We followed all of the 260 adults with prediabetes who had activated their referral to the program as a result of an NHS consultation between December 2018 and March 2019 and followed them for 12 months (N=260; mean age 44.7, SD 9.48 years; 36.1% (94/260) women; mean glycated haemoglobin A1c (HbA1c) 6.25%, SD 0.11%; mean body weight 77.1kg, SD 17.5kg; taking mean 0.41, SD 0.49 diabetes medications).
Results:
Of the 260 participants followed, 221 (85%) individuals reported outcomes at 12 months. 122 (46.9%) completed 80% or more of lessons of the program. Of the 260 participants with a starting HbA1c at or above the prediabetes threshold of 6.0%, 124 (49.6%) reduced their HbA1c to below the threshold. Over a third (33.8%, 88/260) of all participants lost at least 5% of their body weight. Overall, glycaemic control and weight loss improved, especially for participants who completed all modules of the program. For example, participants who engaged in at least 10 of the 12 weekly modules reduced their HbA1c from 6.3% to 5.8% (P<.001) and lost an average of 4.38kg or 5.4% of their body weight (P<.001).
Conclusions:
A smart-phone delivered program that teaches a carbohydrate-reduced diet to adults with prediabetes with behaviour change support can be scalable and effective for glycaemic control, weight loss and can act as an engaging intervention for diabetes prevention.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.