Digital, Blended Lifestyle Intervention for Type 2 Diabetes Remission
- Conditions
- Diabetes Mellitus, Type 2
- Interventions
- Behavioral: Lifestyle intervention
- Registration Number
- NCT05346614
- Lead Sponsor
- Ancora Health B.V.
- Brief Summary
410 Dutch type 2 diabetes patients will be randomized using a 5:1 ratio to intervention group versus control, to a lifestyle intervention program given via a mobile application and digital platform. Active participants will undergo diabetyping, where blood glucose and c-peptide responses to a glucose challenge are measured, and be recommended to follow a calorie-restricted (minimum 500 kcal deficit) low-carbohydrate, or restricted carbohydrate (120g) Mediterranean diet and customized exercise program for a period of 24 weeks. Individuals will then be followed for a period of 2 years following the intervention.
- Detailed Description
Patients will partake in a 24-week intervention followed by a two-year follow-up period. The intervention will consist of diabetic phenotyping (diabetyping), and a personalized app-based lifestyle intervention, done in conjunction with usual care, the so-called blended care model. Individuals will be allocated to either a high (unsaturated) fat, low-carbohydrate Mediterranean (50 g), or the Mediterranean with limited carbohydrates (120 g) diet based on their diabetype, insulin use, and personal preference. This will be given in conjunction with physical activity program, which will focus more on aerobic activity or resistance training depending on diabetype. All participants will be provided with additional coaching to support behavioral change, which will include aspects of diet, physical activity but also aspects of mindfulness, and emotion regulation. The participants will be assessed at screening, before the start of the maintenance phase, and at follow-ups one, two, and three. Control patients will follow the usual care and will also be followed up, following the same schedule. The treatment is further clarified below:
Prior to commencing the study, participants in the active intervention group will receive a kit containing all the necessary products (i.e. wearable, smart scale, and glucose monitor), information, and instructions (where applicable) for participating in the study. Moreover, they will be carefully informed about the types of personalisations available to them. The participants will have either a whole food type diet or a low carbohydrate diet recommended to them based on their metabolic profiles. In addition, they will also have specific types of exercise recommended to them. Participants' treating physicians and coaches will be informed about their choices, and will receive supporting medication adjustment documents, based on those made in previous studies. It will remain the responsibility of the treating physicians to adjust any medications the participants are receiving.
The control group is required to meet the same criteria as the intervention group. The control group only receives health assessments (with the exception of the diabetyping), and will not receive any health intervention. They will continue to receive standard diabetes care.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 410
- Diabetes: Diagnosis of T2DM without physician defined end-organ failure
- BMI: 25 to 45 kg/m²
- Age: 18 to 75 years
- Most recent HbA1c value should be greater than 6.0% (>43 mmol/mol); if less than 6.5% (<48 mmol/mol), individuals should still be receiving anti-diabetic medication
- Tech-savvy (patients are required to be able to fully use smartphone or tablet)
- Display interest and motivation to enroll in a digital, lifestyle intervention for diabetes
- Weight loss of more than five kg or greater than 10% within the past six months
- Serious co-morbidities, for example, a severe form of chronic obstructive pulmonary disease (Gold III or IV), bariatric surgery, heart failure (classes 2-4) kidney failure, or another medically determined end-stage organ failure
- Substance abuse
- Learning difficulties limiting the participation in a digital health intervention and or limiting the comprehension of trial goals or coaching curriculum.
- Current treatment with anti-obesity drugs
- Pregnancy, consideration of pregnancy within the study period, lactation or having given birth within the previous nine months
- Hospital admission for depression
- Major psychiatric disorder (e.g., schizophrenia, bipolar disorder) or use of antipsychotic drugs.
- Currently uncontrolled or eating disorder or purging behavior
- Type 1 diabetes
- History of keto-acidosis
- Myocardial infarction, stroke, angina, or coronary insufficiency within the previous six months
- Diabetic retinopathy requiring treatment
- Creatinine > 2.0 mg·dL-1 or > 152.5 µmol·L-1
- Urinary albumin > 1 g·dL-1 or > 10 g·L-1
- Cancer requiring treatment in the past five years, with the exception of non-melanoma skin cancer
- Chronic infectious disease requiring ongoing treatment
- Other chronic diseases or conditions likely to limit lifespan to less than six years
- Severe visual impairment or other impairment preventing interaction with digital content
- Non-English or Non-Dutch speaking
- Excessive alcohol intake (acute or chronic) defined as the average consumption of three or more alcohol-containing beverages daily or consumption of more than 14 alcoholic beverages per week
- Cholelithiasis or biliary dysfunction
- Use of an insulin pump
- Participation in diabetes therapy within the preceding three years; participation in concurrent weight management or interventional research protocol,
- Untreated thyroid disease,
- Requirement of a prescribed medical diet
- A recent on-record estimated glomerular filtration rate of less than 30 mL/min per 1.732 m²
- Incapacitated patients, and thus unable to fully participate in the trial.
- uncontrolled blood pressure (SBP > 170 mmHg and/or DBP > 100 mmHg)
- For nutritional ketosis specifically: impaired hepatic function (Bilirubin >2 mg·dL-1 or >34.2 µmol·L-1, Albumin < 3.5 g·dL-1 or <35 g·L-1)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Active lifestyle intervention Lifestyle intervention Individuals in the active intervention group will undergo diabetyping (diabetes type 2 phenotyping: glucose, and C-peptide responses to a glucose challenge). Based on the diabetype, individuals will receive recommendations to follow either a calorie-restricted (500kcal deficit minimum) low carbohydrate or a modified Mediterranean diet for a period of 18 weeks (total intervention is 24 weeks). Secondly, individuals will follow a personalized exercise program. Guidance and coaching (individual and small group) will be given via mobile app and digital platform. Individuals will receive real-time feedback based on their diet, exercise, and glucose levels (via continuous glucose monitoring for 4 weeks). Medications will be slowly withdrawn over the intervention period, with a focus on the first phase of the intervention.
- Primary Outcome Measures
Name Time Method Rate of diabetes remission 1 year Percentage of patients achieving complete diabetes remission. Diabetes remission rates amongst the active intervention group will be reported as the number of participants who have achieved fasting glucose \< 7 mmol/L or HbA1c \< 6.5% (48 mmol/mol) on two separate occasions 6 months apart, and glucose-lowering therapy has been stopped.
- Secondary Outcome Measures
Name Time Method Remission versus diabetype Will be reported at all follow-up moments (6 months, 1 year, and 2 years) The association between diabetype\* as determined by response to an oral glucose tolerance test with remission will be determined
\* de Hoogh IM, Oosterman JE, Otten W, et al. The Effect of a Lifestyle Intervention on Type 2 Diabetes Pathophysiology and Remission: The Stevenshof Pilot Study. Nutrients 2021;13(7):2193.Rates of improved glycaemic control Will be reported at all follow-up moments (6 months, 1 year, and 2 years) Percentage of patients achieving improved glycaemic control. This will be defined as the number of individuals who achieve a reduction in glycated hemoglobin (HbA1c), and or reduced dependence on glucose-lowering medications, defined as the number of medications or dose.
Blood lipids Will be reported at all follow-up moments (6 months, 1 year, and 2 years) Changes in blood lipids, namely triglycerides, total cholesterol, LDL, and HDL will be measured as an indicator of health status
Compliance Up to 1 year Compliance will be assessed as a score based on the user's participation and success in coaching activities, educational sessions, and diet, physical activity and blood sugar measurement logging goals.
Cost effectiveness Will be reported at all follow-up moments (6 months, 1 year, and 2 years) The cost of the intervention will be analyzed in comparison with that of usual care, in terms of doctor and hospital visits, as well as the use of supportive medical care ex. physiotherapy.
Weight loss Will be reported at all follow-up moments (6 months, 1 year, and 2 years) Weight loss will be measured as change in weight compared to baseline. It will be measured as an indicator of participant compliance and feasibility of the program.
Digital engagement as measured by the Engagement Index Up to 1 year Digital engagement will be digitally recorded as an engagement index, which is based on the frequency of user engagement with the app and digital content.
Trial Locations
- Locations (4)
Center Medische Kwartier Eindhoven
🇳🇱Eindhoven, Noord Brabant, Netherlands
Haga Ziekenhuis
🇳🇱Den Haag, Zuid Holland, Netherlands
Huisartsenpraktijk Zonneoord
🇳🇱Den Haag, Zuid Holland, Netherlands
St. Anna Ziekenhuis
🇳🇱Eindhoven, Limburg, Netherlands