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Using Digital Technology for Diabetes Prevention Delivery and Engagement

Despite medical and technological advances in diabetes care, the prevalence of diabetes continues to rise. It is becoming critically important to use technology not only to improve diabetes management but also for delivery and engagement in Lifestyle Change Programs for the prevention of type 2 diabetes. Based on the Diabetes Prevention Program and the DPPOS, intense lifestyle intervention aimed at weight loss decreased the incidence of type 2 diabetes by 58% at study’s end and had a long-lasting risk reduction of 25% by 22 years.

The National Diabetes Prevention Program (National DPP) in the United States is a widely available Lifestyle Change Program for people with prediabetes with the goal of 5% weight loss, improvement in food quality and quantity to promote weight loss and an increase in physical activity. Technology can improve access to the program, delivery, engagement, and effectiveness of the National DPP. This seminar will discuss how to use technology to deliver the National DPP, best practices around synchronous delivery and engagement, how asynchronous delivery can augment the program, and how digital technologies can support effectiveness.

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Dietary modifications are crucial for managing newly-diagnosed type-2 diabetes mellitus (T2DM) and preventing its health complications, but many patients fail to achieve clinical goals with diet alone.

We previously developed a machine-learning algorithm for predicting personalized postprandial glucose responses (PPGR) to meals using clinical and gut microbiome features, and showed that dietary interventions based on this algorithm successfully lowered PPGRs in adults with prediabetes. Here, we sought to evaluate the clinical effects of a personalized postprandial-targeting (PPT) diet on glycemic control and metabolic health in individuals with newly-diagnosed T2DM.

We preformed a short-term randomized controlled crossover trial and compared the effects of an algorithm-based personalized postprandial-targeting (‘PPT’) diet, to those of a commonly used Mediterranean-style (MED) diet on glucose levels in 23 newly diagnosed T2DM subjects. The PPT diet lead to significant decrease in glycemic parameters as compared to the MED diet, for example, average PPGR (mean difference between diets, -19.8±16.3 mg/dl×h, p<0.001), mean glucose (mean difference between diets, -7.8±5.5mg/dl, p<0.001), daily time of glucose levels >140mg/dl (mean difference between diets, -2.42±1.7 hour/day, p<0.001) and blood fructosamine (mean change difference between diets, -16.4±37μmol/dl, p<0.0001). We further evaluated the long-term clinical effects of the PPT diet in 16 of the participants by an additional 6-month PPT intervention program, and found significant improvements in multiple metabolic health parameters, including HbA1c (mean±SD, -0.39±0.48%, p<0.001), fasting plasma glucose (FPG) (-16.4±24.2mg/dl, p=0.02) , fasting insulin (-2.3±4.0MCU/ml, p=0.04), triglycerides (-49±46mg/dl, p<0.001) and body composition measurements including body fat% (-2.5±3%, p=0.005) and waist circumference (-4.7±3.7cm, p=0.001). Importantly, 61% of the participants exhibited diabetes remission at the end of the intervention, as measured by HbA1c. Finally, we show that some of the improvements in clinical outcomes were accompanied by significant alterations to the gut microbiome composition per person.

Our findings suggest that a personalized postprandial-targeting diet may be an effective alternative treatment compared to standard dietary approaches for improving glycemic control in newly diagnosed T2DM.