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Arjun Panesar; Charlotte Summers

Arjun Panesar; Charlotte Summers

Diabetes.Co.UK

Title: A Digitally Delivered Low-Carbohydrate Type 2 Diabetes Self-Management Program

Biography

Biography: Arjun Panesar; Charlotte Summers

Abstract

Program Topic Areas:

1. Diabetes, obesity, metabolic health

2. Digital Health

3. Nutritional guidelines and best practice

Overview:

For the past few decades, diet and lifestyle programs for adults with type 2 diabetes have included recommendations to follow a low-fat diet, often using in-person programs. In

parallel, however, research has shown that carbohydrate-reduced diets may more effectively reduce body weight, improve glycemic control, and reduce hypoglycemic medications. Plus, online interventions have shown promise for encouraging these dietary changes. The Low Carb Program has combined these approaches, teaching a carbohydrate reduced, real-food way of eating to adults with type 2 diabetes supported by digital approaches enabling behaviour change and sustainable health improvements.

The goals of this talk are to:

(1) examine the preliminary efficacy of these carbohydrate-reduced digital interventions for reducing body weight, improving glycemic control, and reducing hypoglycemic medications in adults with type 2 diabetes.

(2) Highlight the efficacy of a digital intervention as a method of delivery and behavior change support. The presenters will talk about a commercially available digitally supported program that teaches a low-carbohydrate diet using online videos- and handout-based lessons, weight self-monitoring, dietary self-monitoring, digital social support groups, and medication management through the participants' own healthcare team. Results will be presented from a prospective longitudinal study. Overall, it is the presenters hope that the audience will be provided with new ways to think about diet and lifestyle interventions for adults with type 2 diabetes.

Learning Objectives:

- Learn how the Low Carb Program, a digital health intervention has been enabling adults with type 2 diabetes to implement a carbohydrate-reduced diet and lifestyle, in particular, understand how the components of this automated online low-carbohydrate program influence behaviour change

- Understand the potential impact of carbohydrate-reduced diets on weight loss, glycemic control, and medication reduction in adults with type 2 diabetes.

ABSTRACT

Background

Type 2 diabetes has serious health consequences including blindness, amputation, stroke, and dementia, and its annual global costs are more than $800 billion. Although typically considered a progressive, nonreversible disease, some researchers and clinicians now argue that type 2 diabetes may be effectively treated with a carbohydrate-reduced diet.

Objectives

Our objective was to evaluate the 1-year outcomes of a digitally delivered Low Carb Program (LCP), a nutritionally focused, 10-session educational intervention for glycemic control and weight loss for adults with type 2 diabetes. The program reinforces carbohydrate restriction using behavioral techniques including goal setting, peer support, and behavioral self-monitoring.

Methods

The study used a quasi-experimental research design comprised of an open-label, singlearm pre- and post-intervention using a sample of convenience. From adults with type 2 diabetes who had joined the program and had a complete baseline dataset, we randomly selected participants to be followed for 1 year (N=1000; mean age 56.1, SD 15.7, years; 59% (593/1000) women; mean HbA1c 7.8, SD 2.1, %; mean body weight 89.6, SD 23.1, kg; taking an average of 1.2 diabetes medications).

Results

Of the 1,000 study participants, 708 (70.8%) individuals reported outcomes at 12 months, 672 (67.2%) completed at least 40% of the lessons, and 528 (52.8%) completed all lessons of the program. Of the 743 participants with a starting HbA1c at or above the type 2 diabetes threshold of 6.5%, 195 (26.2%) reduced their HbA1c to below the threshold while taking no glucose-lowering medications or just metformin. Of the participants who were taking at least one hypoglycemic medication at baseline, 40.4% (289/714) reduced one or more of these medications. Almost half (46.4%, 464/1000) of all participants lost at least 5% of their body weight. Overall, glycemic control and weight loss improved, especially for participants who completed all 10 modules of the program. For example, participants with elevated baseline HbA1c (≥7.5%) who engaged with all 10 weekly modules reduced their HbA1c from 9.2% to 7.1% (P<.001) and lost an average of 6.9% of their body weight (P<.001).

Conclusions

Especially for participants who fully engage, an online program that teaches a carbohydratereduced diet to adults with type 2 diabetes can be effective for glycemic control, weight loss, and reducing hypoglycemic medications.