Web-Based Interventions Improve Diet, Weight in Patients With T2D
NOVEMBER 14, 2017
Boris Hansel, MDPatients with type 2 diabetes (T2D) that also have abdominal obesity could benefit from the utilization of web-based interventions when it comes to improving dietary habits and positive clinical changes.
Led by Boris Hansel, MD, an endocrinologist specializing in obesity management in the Department of Endocrinology, Diabetology, and Nutrition at Hôpitaux Universities Paris-Nord Val de Seine in Paris, France, the study revealed that use of the fully automated Accompagnement Nutritionnel de l’Obésité et du Diabète par E-coaching (ANODE) program showed a significant improvement in body weight, waist circumference, and changes in hemoglobin A1C (HbA1C) compared to generic treatment advice.
"Doctors lack time in their consultation to optimally monitor the nutrition of their diabetic patient," Hansel told MD Magazine. "Our study shows that this e-coaching service could relieve doctors and would strengthen the doctor-patient relationship around other medical issues."
The ANODE programs consisted of 4 modules - a self-monitoring dietary and physical activity feature to assess habits and keep participants aware of their intake, a generator of a balanced diet menu, a nutritional assessment that also provided advice, and a physical activity education and prescription program.
Over the 16 weeks of the trial, 120 patients were randomized 1:1 to either the ANODE program (n = 60), which they were asked to log onto at least once per week or the control group (n = 60), which received general advice on nutrition. The ANODE group’s amount of human contact was limited within the program to only a hotline for technical support.
Patients were, on average, 57 years old with a mean body mass index (BMI) of 33 kg/m2 and a mean HbA1C of 7.2%. Women accounted for 66.7% of participants.
The trial judged changes in dietary score, based on the International Diet Quality Index (DQI-I) from baseline to week 16. Secondary outcomes were changes in body weight, waist circumference, HbA1C, and maximum oxygen consumption (VO2 max).
Compared to the control group (-1.68, standard deviation [SD] 5.18) the ANODE arm of the study experienced a significant increase in DQI-I score (+4.55; SD 5.91; P <.001). At baseline, the ANODE arm recorded DQI-I scores of 54.0 (SD 5.7) compared to 52.8 in the control arm (SD 6.2; P =.28).
Additionally, in the ANODE arm, alterations to dietary intake leaned toward healthier foods and differed for lipids (P =.02), saturated fast (P <.01), sodium (P =.07), and empty calories (P =.06).
Of the 60 patients in the ANODE arm, 33.3% (n = 20) experienced a weight loss >3% compared to 6.7% (n = 4; P <.01) in the control arm, while 20% (n = 12) experienced weight loss of >5% compared to 3.3% (n = 2; P <.01) in the control arm.
In the ANODE arm, 3.3% (n = 2) lost >10% of body weight (P =.15) while none did so in the control arm. Overall, the ANODE group lost 3.0 kg on average compared to 1.4 kg for the control arm. The study authors noted that the results have yet to be confirmed on a long-term basis.
The participants in the ANODE group were also asked to respond to a satisfaction survey about their experience with the program, of which 92% (n = 55) did. The responses showed a recommendation rate of 70%, while no patients reported difficulties with the program.
"E-coaching is the way of the future, but will never replace the doctor's presence or the doctor-patient relationship," Hansel said. "Emerging data on this topic suggest that this could, however, solve the problem of medical deserts, and would effectively improve the medical care of patients."
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