Recent controlled trials have demonstrated that type 2 diabetes (T2D) remission is possible with significant weight loss in people with newly diagnosed T2D. However, current programs focus on face-to-face education and behavior change, which limit scalability and inclusivity. We examined the effect of a digital education and behavior change program targeting a very low-calorie diet on metabolic control, insulin sensitivity as well as liver fat and fibrosis.
Patients with diet/metformin controlled T2D (n=8, 50% male, 52±12 years, BMI 33±4 kg/m2) were remotely supported to undertake a very low-calorie (800 kcal/day) diet using digital education, behavior change and tracking with one-to-one tele-coaching for 12 weeks. Insulin sensitivity index was calculated using a mixed-meal tolerance test, liver fat content by 1H-magnetic resonance spectroscopy and liver fibrosis by elastography. After 12 weeks, participants had reduced their body weight by 9.0±3.6 kg and HbA1c (6.6±1.2% vs. 6.0±0.6%, p=0.05) and improved insulin sensitivity (319±61 vs. 355±49 ml.min-1.m-2, p<0.05). Liver fat content declined (9.8±8.2% to 3.3±3.1%, p<0.01) alongside with measures of liver fibrosis (7.0±3.1 to 4.4±1.3 kPa, p=0.05). Changes of liver fat were directly correlated with changes in body weight (r=0.80, p<0.05) as well as changes in fasting plasma glucose (r=0.85, p<0.01) and HbA1c (r=0.91, p<0.01). Within 12 weeks. 38% of participants achieved remission of T2D (HbA1c <6.5%) and 50% normalized liver fat (intrahepatic fat content <5.6%).
In conclusion, this feasibility study demonstrates that digital education, behavior change and tracking can reduce body weight which conveys significant improvements in metabolism and liver health. These preliminary data suggest that care teams should explore how digital education and behavior change can enhance existing care for people with newly diagnosed T2D with a view to achieving remission.
D. Pesta: None. O.P. Zaharia: None. Y. Kupriyanova: None. J. Hwang: None. D.F. Markgraf: Research Support; Self; Sanofi. M. Trenell: Other Relationship; Self; Changing Health Ltd. J. Szendroedi: None. M. Roden: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Poxel SA, Servier. Board Member; Self; Eli Lilly and Company. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi. Speaker's Bureau; Self; Novo Nordisk Inc.
EIT Health; German Ministry of Culture and Science of the State of North Rhine-Westphalia; German Federal Ministry of Health; German Federal Ministry of Education and Research