Previously submitted to: JMIR Diabetes (no longer under consideration since Oct 25, 2022)
Date Submitted: Aug 11, 2022
Warning: This is an author submission that is not peer-reviewed or edited.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.
Associations among Continuous Glucose Monitoring, Engagement, and Weight Loss in a Digital Diabetes Self-Management Education and Support Program: A Non-randomized Retrospective Cohort Study
ABSTRACT
Background:
Modest weight loss is recommended for individuals with type 2 diabetes (T2D) to help improve glycemic control and reduce cardiovascular disease risk. Continuous glucose monitoring (CGM) is recommended as a standard of care for individuals with T2D who use insulin, but more research is needed to inform recommendations for CGM use in all T2D populations. Digital diabetes self-management programs can help individuals with T2D lose weight and improve glycemic control. Less is known about the impact of CGM on program engagement within digital programs for diabetes self-management and the relationship between CGM use and weight loss for those with T2D.
Objective:
The primary objective of this study was to examine the difference in percent weight loss from baseline to 6 months between CGM users and non-users among commercially insured members with T2D in a digital program for diabetes self-management (Omada for Diabetes).
Methods:
A non-randomized retrospective observational cohort study was performed using data from 2,612 Omada for Diabetes program members (mean age=52.3 years, 56.4% female, 63.5% white) who started the program between January 1, 2021 and September 30, 2021. Data analyses examined the difference in percent weight loss over 6 months between CGM users and non-users overall as well as stratified by body mass index, program engagement, and CGM-adherence, and associations between program engagement and CGM group.
Results:
A higher percentage of CGM users (57.6%) than non-users (48.4%) were classified as ‘highly engaged’ with the Omada for Diabetes program (p<.001). Both groups showed significant within-group mean percent weight loss from baseline to 6 months (-2.0% CGM users, -1.8% non-users, p<.001), but no differences were detected between groups. When stratified by program engagement, highly engaged CGM users and non-users had significantly greater percent weight loss compared to those with normal/low engagement (CGM users: -2.50% vs. -1.33%, p=.004; non-users: -2.43% vs. -1.30%, p<.001). In fully adjusted models, CGM users and non-users had significant reductions in percent weight loss (β=-2.0%, 95% CI (-2.42, -1.57), β=-1.87%, 95% CI (-2.11, -1.63), respectively).
Conclusions:
Members participating in the Omada for Diabetes program had a significant change in mean percent body weight from program start to 6 months regardless of CGM status. A higher percentage of CGM users were more engaged with the program than non-users, and higher engagement across both groups was associated with greater percent weight loss. Further understanding the impact that CGM has in digital diabetes self-management programs for T2D could enhance program effectiveness, encourage sustained engagement, and inform standard of care recommendations. Clinical Trial: N/A
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