A Fully Automated Web-Based Program Improves Lifestyle Habits and HbA1c in Patients With Type 2 Diabetes and Abdominal Obesity: Randomized Trial of Patient E-Coaching Nutritional Support (The ANODE Study)

Abstract

BackgroundThe prevalence of abdominal obesity and type 2 diabetes mellitus (T2DM) is a public health challenge. New solutions need to be developed to help patients implement lifestyle changes.ObjectiveThe objective of the study was to evaluate a fully automated Web-based intervention designed to help users improve their dietary habits and increase their physical activity.MethodsThe Accompagnement Nutritionnel de l’Obésité et du Diabète par E-coaching (ANODE) study was a 16-week, 1:1 parallel-arm, open-label randomized clinical trial. Patients with T2DM and abdominal obesity (n=120, aged 18-75 years) were recruited. Patients in the intervention arm (n=60) had access to a fully automated program (ANODE) to improve their lifestyle. Patients were asked to log on at least once per week. Human contact was limited to hotline support in cases of technical issues. The dietetic tool provided personalized menus and a shopping list for the day or the week. Stepwise physical activity was prescribed. The control arm (n=60) received general nutritional advice. The primary outcome was the change of the dietary score (International Diet Quality Index; DQI-I) between baseline and the end of the study. Secondary endpoints included changes in body weight, waist circumference, hemoglobin A1c (HbA1c) and measured maximum oxygen consumption (VO2 max).ResultsThe mean age of the participants was 57 years (standard deviation [SD] 9), mean body mass index was 33 kg/m² (SD 4), mean HbA1c was 7.2% (SD 1.1), and 66.7% (80/120) of participants were women. Using an intention-to-treat analysis, the DQI-I score (54.0, SD 5.7 in the ANODE arm; 52.8, SD 6.2 in the control arm; P=.28) increased significantly in the ANODE arm compared to the control arm (+4.55, SD 5.91 vs -1.68, SD 5.18; between arms P<.001). Body weight, waist circumference, and HbA1c changes improved significantly in the intervention.ConclusionsAmong patients with T2DM and abdominal obesity, the use of a fully automated Web-based program resulted in a significant improvement in dietary habits and favorable clinical and laboratory changes. The sustainability of these effects remains to be determined.Trial RegistrationClinicalTrials.gov NCT02343107; http://clinicaltrials.gov/ct2/show/NCT02343107 (Archived by WebCite at http://www.webcitation.org/6uVMKPRzs)

Distribution of glycated haemoglobin and its determinants in Indian young adults

“…The present study describes the glycosylated A1c levels from a large cohort of individuals sampled equally across urban and rural areas from India, and also highlights the utility of IDRS for identifying individuals at high risk for T2DM which correlate to these levels. The results from the current study highlights a high prevalence of T2DM in young Indian adults which indicates the need of lifestyle modification [41,50] in order to halt or delay the onset of Diabetes among in Young adults. Thus, it is imperative to institute public health measures like exercise and Yoga [51,[52][53][54] along with dietary modifications [55,56].…”

“…According to WHO, obesity in childhood and adolescence increases at a higher rate in developing countries of Asia and Africa [40]. Association between abdominal obesity and Diabetes has also been reported in number of studies [41][42][43]. The prevalence of Diabetes and Prediabetes was found reduced among vigorous exercise group in our study [44][45][46].There is a marginal difference in diabetic cases among the mild (7.4%) and moderate (7.6%) physical activity group.…”

Expression and influence of pentraxin-3, HbAlc and ApoA1/ApoB in serum of patients with acute myocardial infarction combined with diabetes mellitus type 2

“…HbA1c is a product of non-enzymatic glycation reaction of hemoglobin which occurs slowly and continuously under the action of hyperglycemia. The increase of HbA1c leads to the acceleration of vasoconstriction, which increases gene expression of chemokines and adhesion molecules, speeds up lymphocytes and monocytes transferring into the vessel wall, and promotes the formation of atherosclerotic plaques ( 17 – 19 ). HbA1c is a commonly used clinical indicator for glycemic control in DM, and it can indirectly reflect the severity of DM condition in patients.…”

The “A to Z” of Managing Type 2 Diabetes in Culturally Diverse Populations

“…Diabetes information technology programs have contributed to improve diabetes self-care behaviors. For instance, among obese patients with type 2 diabetes, a web-based patient education program led to an improvement in nutrition patterns and some patient related outcomes ( 135 ). However, patients with type 2 diabetes don't routinely participate in e-health activities.…”