Methods

We conducted an open-label, non-randomized, controlled, before-and-after 1-year study of this continuous care intervention (CCI) and usual care (UC). Primary outcomes were glycosylated hemoglobin (HbA 1c), weight, and medication use. Secondary outcomes included fasting serum glucose and insulin, HOMA-IR, blood lipids and lipoproteins, liver and kidney function markers, and high-sensitivity C-reactive protein (hsCRP).

Results

349 adults with T2D enrolled: CCI: n= 262 [mean (SD); 54 (8) years, 116.5 (25.9) kg, 40.4 (8.8) kg m 2, 92% obese, 88% prescribed T2D medication]; UC: n= 87 (52 (10) years, 105.6 (22.15) kg, 36.72 (7.26) kg m 2, 82% obese, 87% prescribed T2D medication]. 218 participants (83%) remained enrolled in the CCI at 1 year. Intention-to-treat analysis of the CCI (mean±SE) revealed HbA 1c declined from 59.6±1.0 to 45.2±0.8 mmol mol− 1 (7.6±0.09% to 6.3±0.07%, P< 1.0× 10− 16), weight declined 13.8±0.71 kg (P< 1.0× 10− 16), and T2D medication prescription other than metformin declined from 56.9±3.1% to 29.7±3.0%(P< 1.0× 10− 16). Insulin therapy was reduced or eliminated in 94% of users; sulfonylureas were entirely eliminated in the CCI. No adverse events were attributed to the CCI. Additional CCI 1-year effects were HOMA-IR− 55%(P= 3.2× 10− 5), hsCRP− 39%(P< 1.0× 10− 16), triglycerides− 24%(P< 1.0× 10− 16), HDL-cholesterol+ 18%(P< 1.0× 10− 16), and LDL-cholesterol+ 10%(P= 5.1× 10− 5); serum creatinine and liver enzymes (ALT, AST, and ALP) declined (P≤ 0.0001), and apolipoprotein B was unchanged (P= 0.37). UC participants had no significant changes in biomarkers or T2D medication prescription at 1 year.

Conclusions

These results demonstrate that a novel metabolic and continuous remote care model can support adults with T2D to safely improve HbA 1c, weight, and other biomarkers while reducing diabetes medication use.