Improving insulin sensitivity, liver steatosis and fibrosis in type 2 diabetes by a food-based digital education-assisted lifestyle intervention program: a feasibility study

Abstract

Purpose Recent trials demonstrated remission of type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) following formula diet-induced weight loss. To improve the outreach for populations in need, many mobile health apps targeting weight loss have been developed with limited scientific evaluation of these apps. The present feasibility study investigated the effects of a novel approach incorporating a regular ‘whole food-based’ low-calorie diet combined with app-based digital education and behavioral change program on glucose metabolism and disease management. Methods Twenty-four individuals with type 2 diabetes followed this approach supported by weekly coaching calls for 12 weeks. Phenotyping included bioimpedance analysis, mixed-meal tolerance test, magnetic resonance spectroscopy and transient elastography for assessing liver fat content and liver stiffness. Results Over 12 weeks, participants reduced their body weight by 9% (97 ± 13 to 88 ± 12 kg), body mass index (BMI; 33 ± 5 to 29 ± 4 kg/m2), total fat mass (31 ± 10 to 27 ± 10%) (all p < 0.01) and liver fat by 50% alongside with decreased liver stiffness. Target HbA1c (< 6.5%) was achieved by 38% and resolution of NAFLD (liver fat content < 5.6%) was observed in 30% of the participants. Conclusion This novel approach combining digital education with a low-calorie diet results in effective improvements of body weight, glycemic control and NAFLD and could complement existing care for patients with type 2 diabetes. Trial registration NCT04509245

The Key Digital Tool Features of Complex Telehealth Interventions Used for Type 2 Diabetes Self-Management and Monitoring With Health Professional Involvement: Scoping Review

“…The 42 studies were published between January 1, 2010, and March 31, 2022, with as many as 28 (67%) published within the past 6 years [ 29 - 56 ]. We found that, in 2021, nearly twice as many articles were published on the topic as in each of the previous 4 years ( Figure 2 ).…”

“…Information on complex telehealth interventions used for diabetes self-management and monitoring with health professional involvement was obtained for 18 countries. Of the 42 studies, 11 (26%) were conducted in the United States [ 30 , 31 , 39 , 48 - 51 , 57 - 59 ]; 5 (12%) in South Korea [ 37 , 41 , 44 , 60 , 61 ]; 4 (10%) in Singapore [ 29 , 43 , 46 , 55 ]; 4 (10%) in Norway [ 32 , 62 , 63 ]; 3 (7%) in the United Kingdom [ 33 , 35 , 38 ]; 3 (7%) in Germany [ 40 , 45 , 56 ]; 2 (5%) in China [ 47 , 64 ]; and 1 (2%) each in Australia [ 54 ], South Africa [ 65 ], Spain [ 66 ], Iran [ 52 ], Italy [ 67 ], Japan [ 42 ], Lebanon [ 34 ], Slovenia [ 36 ], Switzerland, and Taiwan [ 68 ] ( Figure 3 ).…”

“…One-third (14/42, 33%) of the studies were randomized controlled trials [ 35 , 36 , 40 - 42 , 46 , 47 , 55 , 57 - 59 , 62 , 64 , 67 ], with most of them (n=12, 86%) ranging from 6 months to 1 year in duration. Of the 42 studies, 9 (21%) were feasibility studies, with the interventions ranging from 3 months to 1 year in duration [ 33 , 38 , 39 , 43 , 44 , 51 , 53 , 56 , 71 ]; 8 (19%) were interventional studies, with the interventions ranging from 3 to 18 months in duration [ 30 , 31 , 34 , 48 , 50 , 54 , 63 , 68 ]; 5 (12%) were conceptual studies lasting 6 months [ 45 , 49 , 52 , 65 , 66 ]; and 4 (10%) were pre-post studies, in which the interventions ranged from 1 month to 1 year in duration [ 29 , 37 , 60 , 61 ] ( Figure 4 ).…”

“…Of the 42 studies, 21 (50%) included physicians [ 29 - 32 , 36 , 40 - 42 , 45 , 47 - 51 , 53 , 58 , 60 , 64 , 66 , 68 , 69 ], 16 (38%) involved dietitians [ 29 , 31 , 33 , 35 , 39 , 43 , 46 , 54 , 56 , 59 , 60 , 65 , 68 - 70 , 72 ], 12 (29%) involved nurses [ 31 , 32 , 36 , 41 , 55 , 58 - 62 , 68 , 69 ], 4 (10%) involved psychologists [ 31 , 33 , 67 , 69 ], 4 (10%) involved physical educators [ 29 , 33 , 35 , 60 ], and 3 (7%) involved case managers [ 36 , 60 , 68 ]. Finally, of the 42 studies, 13 (31%) involved a multidisciplinary team [ 29 , 31 - 33 , 35 , 36 , 41 , 58 - 60 , 68 , 69 , 72 ], and 22 (52%) involved only 1 clinician [ 30 , 39 , 40 , ...…”

A Review of the Epidemiology, Pathophysiology, and Efficacy of Anti-diabetic Drugs Used in the Treatment of Nonalcoholic Fatty Liver Disease

“…In the future, digital education will likely assume increasing importance in the management of NAFLD. In a recently conducted clinical trial, 12 weeks of diet and exercise supported by digital education reduced body weight by ~ 9% and resolved NAFLD in 30% of participants with NAFLD and T2DM [46]. A major limitation of all lifestyle modification programs is non-compliance and the inability to sustain weight loss beyond the prescribed program.…”