Apps deliver lifestyle change programs to prevent diabetes

An app-based program for lifestyle change effectively helps users achieve significant weight loss and improve glycaemia in adults with prediabetes, according to a recent Singapore study. Such interventions could potentially be used alongside current standard approaches for preventing diabetes.

“The app is designed with an automated algorithm which provides real-time feedback with personal health data tracking, along with personalized health coaching via the app’s chat function,” the researchers said. “With the current study results, there is a possibility that we can leverage on a digital diabetes prevention program to scale up diabetes preventive efforts.”

The multicentre randomized controlled trial enrolled 148 adults with prediabetes (mean age 53.1 years, 60 percent men, body mass index ≥23 kg/m²). Participants were randomly selected to receive either the Nutritionist Buddy (nBuddy) Diabetes app with in-app dietitian coaching for 6 months (intervention group; n=72) or standard diet counselling at baseline (control group; n=76). No participant was taking prediabetes medication.

After 6 months, participants who received the app intervention vs standard baseline counselling saw significantly greater clinically meaningful weight loss (–4.2 kg vs –1.3 kg; p<0.001), defined as a decrease of ≥5 percent in body weight after an overnight fast. The mean percentage weight loss values were likewise significantly higher in the intervention group (5.2 percent and 1.5 percent; p<0.001). [Front Nutr 2022;24:780567]

Generalized Poisson mixed modelling analysis further confirmed that participants allocated to the app-based intervention were more than four times as likely to achieve clinically meaningful weight loss (adjusted relative risk [RR], 4.3, 95 percent confidence interval [CI], 2.0–9.2; p<0.001).

Aside from body weight, the app-based lifestyle change programme led to significant improvements in glycaemic control. After 6 months, a greater proportion of intervention participants achieved normoglycaemia than controls (44.4 percent vs 23.7 percent).

Normoglycaemia, defined as glycated haemoglobin (HbA1c) levels <5.7 percent, was also more than twice as likely to occur in the intervention group (adjusted RR, 2.1, 95 percent CI, 1.1–3.9; p=0.018). Similarly, the mean reductions in HbA1c (–0.22 percent vs –0.06 percent) and fasting blood glucose (–0.37 vs –0.01 mmol/L) were greater in the app users.

Such glycaemic and metabolic improvements could be attributed to positive changes in diet and physical activity. At 6 months, participants on the app-based program showed significantly greater reductions in daily intake of carbohydrates, total fats, saturated fat, sugar, and overall calories relative to controls (p<0.001).

Exercise was likewise higher at 6 months relative to baseline, though the between-group difference failed to reach significance (p=0.084).

Importantly, app utilization was high in the intervention group, reaching 97.8 percent in the first 3 months and dropping only slightly to 91.7 percent by 6 months. Users interacted with their dietitian an average of 3 days per week in the first 3 months and 2 days per week by month 6.

“It is well known that adherence to a diabetes prevention program is a challenge for many people. Hence, a digital platform may bridge the gap for people to access the program at their own convenience and psychological comfort,” the researchers said, pointing out that while current digital interventions have high rates of use, they lack features that allow users to receive feedback from dietitians.

“The nBuddy Diabetes app provides automated calories and carbohydrate evaluation, culturally appropriate healthier alternatives and individualized real-time health coaching,” they said. “We believe that these additional features acting in combination could have empowered participants to achieve the desired health goals.”