Background: The 2021 ADA Standards of Medical Care suggest digital health coaching (DHC) programs can be beneficial in treating diabetes. As programs expand, it is increasingly important to understand expected benefits for diverse populations. Studies have shown greater clinical impact for patients with suboptimal baseline health, yet little is known about the influence of health on behavioral outcomes. In this real-world study, we analyzed trends in lifestyle change by baseline A1c following exposure to a T2DM DHC program.

Methods: The 12-week DHC program, including patient-centered phone, email and/or text interactions, was delivered to T2DM patients. Retrospective analysis of patient reported data at baseline and program completion was conducted to evaluate impact on engagement in CDC recommended physical activity and healthy meal consumption (defined by USDA MyPlate guidelines). Outcomes were analyzed for 3 cohorts stratified by baseline A1c (<7% 7-9%, >9%) using Wilcoxon matched-pairs signed rank tests and paired proportion tests.

Results: Individuals who completed all measures (n=130) were included in the study. A majority (82.30%) reported a baseline A1c ≥ 7%, and 27.69% were high-risk (A1c > 9%). Across all cohorts, there were significant improvements in the percent of participants adherent to CDC guidelines, median weekly activity minutes and number of healthy meals (p<0.01). For subgroup analyses, weekly activity minutes improved the most for the A1c < 7% cohort (50 minutes; p<0.01). Change to weekly healthy meals was greatest for those with an A1c ≥ 7%.

Conclusions: Outcomes suggest that DHC can improve lifestyle behaviors among all individuals with T2DM, irrespective of baseline A1c, with those at an elevated glycemic risk reporting the greatest dietary benefit and those with the lowest risk reporting the greatest shift in physical activity. If confirmed, findings may inform DHC referral strategies and individualized behavioral goals.


M. Martin: Consultant; Self; PACK HEALTH. J. Patterson: None. V. T. Tran: None. B. B. Oconnor: Employee; Self; Pack Health. M. Allison: None. D. Patel: None.

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