Evaluation of the Low Carb Program Digital Intervention for the Self-Management of Type 2 Diabetes and Prediabetes in an NHS England General Practice: Single-Arm Prospective Study

Abstract

Background Type 2 diabetes mellitus has serious health consequences, including blindness, amputation, and stroke. Researchers and clinicians are increasingly in agreement that type 2 diabetes may be effectively treated with a carbohydrate-reduced diet. Digital apps are increasingly used as an adjunct to traditional health care provisions to support remote self-management of long-term health conditions. Objective Our objective was to evaluate the real-world 12-month outcomes of patients prescribed the Low Carb Program digital health intervention at a primary care National Health Service (NHS) site. The Low Carb Program is a nutritionally focused, 12-session, digitally delivered, educational behavior change intervention for glycemic control and weight loss for adults with prediabetes and type 2 diabetes. The program educates and supports sustainable dietary changes focused on carbohydrate restriction by utilizing behavior change techniques, including goal setting, peer support, and behavioral self-monitoring, as well as personalized downloadable resources, including recipes and meal plans tailored to ethnicity, weekly shopping budget, and dietary preferences. Methods This study evaluated the real-world outcomes of patients recruited to the Low Carb Program at an NHS general practice in Southport, United Kingdom. All of the NHS patients recruited to the program were diagnosed with type 2 diabetes or prediabetes and were given access to the program at no cost. A total of 45 participants, with a mean age of 54.8 years (SD 13.2), were included in the study. Women made up 42% (19/45) of the sample. The mean hemoglobin A1c (HbA1c) of the sample was 56.7 mmol/mol (SD 16.95) and the mean body weight was 89.4 kg (SD 13.8). Results Of the 45 study participants recruited to the program, all of them (100%) activated their accounts and 37 (82%) individuals reported outcomes at 12 months. All 45 (100%) patients completed at least 40% of the lessons and 32 (71%) individuals completed more than nine out of 12 core lessons of the program. Glycemic control and weight loss improved, particularly for participants who completed more than nine core lessons in the program over 12 months. The mean HbA1c went from 58.8 mmol/mol at baseline to 54.0 mmol/mol, representing a mean reduction of 4.78 mmol/mol (SD 4.60; t31=5.87; P<.001). Results showed an average total body weight reduction of 4.17%, with an average weight reduction of 3.85 kg (SD 2.49; t31=9.27; P<.001) at the 12-month follow-up point. Conclusions A digital app prescribed to adults with type 2 diabetes and prediabetes in a primary care setting supporting a transition to a low-carbohydrate diet has been shown to be effective in improving glycemic control and enabling weight loss. Further research to understand more about factors affecting engagement with the app and further positive health implications would be valuable.

The Use of Mobile Health Interventions for Outcomes among Middle-Aged and Elderly Patients with Prediabetes: A Systematic Review

“…This systematic review was comprised of 19 studies with randomized trial designs [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ] and 6 studies [ 55 , 56 , 57 , 58 , 59 , 60 ] with other types of trial designs (pragmatic trial and quasi-experimental). The features of the studies are detailed in Table 1 .…”

“…A total 1866 (94.7%) completed the studies from non-randomized trial design. There are eight studies [ 38 , 47 , 49 , 50 , 56 , 58 , 59 , 60 ] that samples of less than 100 participants. There were three studies with a sample size of more than 1300, two RCT studies [ 52 , 61 ] and 1 pragmatic study [ 57 ].…”

“…A total of thirteen studies [ 36 , 39 , 40 , 41 , 43 , 44 , 46 , 48 , 50 , 51 , 53 , 57 , 58 ] only used hbA1c as a diagnostic tool for prediabetes. Research conducted by Ramachandran [ 36 ] only used an oral glucose tolerance test (OGTT) as a diagnostic standard for prediabetes.…”

“…In the Jadad score, the scale runs from 0 to 5, with a score of ≤2 indicating a low-quality report and a score of ≥3 indicating a high-quality report [ 33 ]. Six [ 55 , 56 , 57 , 58 , 59 , 60 ] studies have low quality, according to the analysis. This is due to the trial’s insufficiency of randomization in selecting participants.…”

“…Eighteen [ 38 , 40 , 41 , 42 , 44 , 45 , 46 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 58 ] studies used mobile phone apps as an intervention. There were twelve mobile phone apps [ 37 , 40 , 42 , 45 , 46 , 47 , 51 , 52 , 53 , 54 , 59 ] developed from the Diabetes Prevention Programs (DPP) curriculum for adults at risk of T2DM.…”