Abstract
Digital health coaching is an intervention for type 2 diabetes mellitus (T2DM) that has potential to improve the quality of care for patients. Previous research has established the efficacy of digital interventions for behavior change. This pilot study addresses a research gap in finding effective and accessible behavioral interventions for under-resourced individuals with T2DM. We examined the impact of Healthy at Home, a 12-week phone and SMS-based (short message service) digital health coaching program, on insulin resistance which is an upstream marker for T2DM progression. We compared this intervention to usual diabetic care in a family medicine residency clinic in a randomized controlled trial. Digital health coaching significantly improved participants' calculated Homeostatic Model Assessment for Insulin Resistance (HOMA2-IR) by −0.9 ± 0.4 compared with the control group (p = 0.029). This significance remained after controlling for years diagnosed with T2DM, enrollment in Medicaid, access to food, baseline stage of change, and race (p = 0.027). Increasing access to digital health coaching may lead to more effective control of diabetes for under-resourced patients. This study demonstrates the potential to implement a personalized, scalable, and effective digital health intervention to treat and manage T2DM through a lifestyle and behavioral approach to improve clinical outcomes (http://clinicaltrials.gov, NCT04872647).
Highlights
Type 2 diabetes mellitus (T2DM) is the seventh-leading cause of death in the United States and accounts for 1 in every 4 dollars spent on healthcare [1, 2]
This significance remained when controlling for key Social determinants of health (SDOH) in a patient population where these SDOH were prevalent
Our results suggest that Healthy at Home digital health coaching slowed the natural progression of insulin resistance in T2DM
Summary
Type 2 diabetes mellitus (T2DM) is the seventh-leading cause of death in the United States and accounts for 1 in every 4 dollars spent on healthcare [1, 2]. Diabetes is typically managed with pharmacologic interventions, it is difficult to find clinically significant strategies to improve mortality or macrovascular complications of T2DM with tight glucose control [7,8,9,10,11]. This becomes more difficult the longer a patient is diagnosed with diabetes [12,13,14]. Targeting insulin resistance may decrease both micro- and macrovascular complications of T2DM [15, 23], addressing the rising cost and burden of this disease
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