Visual Abstract
Nutrition therapy is a cornerstone of care for people with T2D, yet implementing and sustaining healthy eating habits can be challenging. Meal delivery is a promising mechanism to couple healthy food intake with a behavior-change intervention. We assessed the impact of 28 days of T2D-friendly, home-delivered meals (3 meals/day) on time in range (TIR) for people with T2D in the virtual care delivery platform Level2. We enrolled 155 people with T2D, not taking insulin, with a TIR < 70% or glucose management index (GMI) > 7% in the month-long pre-inclusion period, 102 of whom opted to enroll 1-2 household members. Of the 155, 45 were excluded from analysis due to sparse CGM data in the baseline or intervention period. From the baseline period to the meal delivery period, on average, TIR improved by 6.8% (95% CI 4.0, 9.7; p < 0.001) and GMI improved by 0.22% (95% CI 0.11, 0.32; p < 0.001), with a 15.5% increase (from 33.6% to 49.1%) in the proportion of participants achieving a TIR above 70% (p = 0.028). Average TIR increased rapidly upon initiation of meal delivery but regressed with cessation of the meals. Our findings suggest the promise of meal delivery to simultaneously impact nutritional intake and change food behaviors, and they highlight the importance of deploying concurrent behavior change strategies to increase the durability of glycemic improvement beyond the meal delivery period.
C. Clark: Employee; Self; UnitedHealth Group, Stock/Shareholder; Self; UnitedHealth Group. B. Hart: Employee; Self; UnitedHealth Group.
