A 6-Month mHealth Low-Carbohydrate Dietary Intervention Ameliorates Glycaemic and Cardiometabolic Risk Profile in People with Type 2 Diabetes

Abstract

Aim: Mobile health (mHealth) applications have been reported to be effective in improving glycaemic control and cardiometabolic health, but mainly as part of shorter-term intervention studies. The aim of this study is to examine the effect of the ongoing Defeat Diabetes mHealth low-carbohydrate diet (LCD) intervention on clinical markers and cardiometabolic risk after 6 months of intervention. Methods: Data were collected via primary care physicians as part of routine T2D monitoring. These included HbA1c (primary outcome), blood pressure, blood lipids, and markers of kidney and liver function. Anthropometrics, as well as changes in the prescription of diabetes, hypertension, and dyslipidaemia medication, were also recorded. Calculated variables, total cholesterol to HDL-c, triglyceride to HDL-c, and waist to height ratios, were analysed to examine changes in cardiometabolic risk profile. Three-day food records were used to assess dietary intake and intervention adherence. Univariate regression models examined changes from baseline to 6 months. Results: Ninety-four participants remained in the study out of the ninety-nine at baseline (mean age 59 ± 11 years, 55 females). After 6 months of intervention, there were significant reductions in HbA1c by -1.0% (95% CI: -1.3 to -0.6), as well as in the liver enzymes ALT (-9.3 U/L 95% CI -16.3 to -2.4) and GGT (-18.8 U/L 95% CI: -31.4 to -6.3) across the cohort. In addition, there was a significant reduction in cardiometabolic risk, as measured by the calculated variables and a decrease in waist circumference (-4.6 cm 95% CI: -8.9 to -0.2). Conclusions: People with T2D receiving LCD education and resources through the Defeat Diabetes mHealth app (version 3.3.8) improved their glycaemic control after 6 months of intervention. Cardiometabolic risk profile and liver function also showed significant improvement. These findings indicate that the use of an LCD digital app is a valuable adjunct in the management of T2D.

Keywords: diabetes management; low carbohydrate; mHealth; nutrition; online; self-management; type 2 diabetes mellitus.

Figure 1

Study process and recruitment.

Figure 2

Participants as grouped by HbA1c, less than 6.5%, greater than or equal to 6.5% and less than 8%, and greater than or equal to 8%, at baseline and after 3 and 6 months of intervention. * indicates the statistically significant difference between baseline and follow-up period (p < 0.05). Note: All participants at baseline recorded an HbA1c of 6.5% or greater as part of the eligibility criteria.