Significant Reduction in Hba1c and BMI After Three Months of Personalized Glycemic Response Based Coaching for Patients With Type 2 Diabetes
Authors: Lathia Tejal , Tanna Snehal , Padsalge Mahesh , Juneja Archana , Ballani Piya , Samudra Kirti , Kalra Sanjay , Wasir Jasjeet , Kothari Sneha Mahendra , Kini Vishal , Sawant Sonali , Ranadive Ruchira , Furia Bijal , Shaikh Misbah , Goel Sugandh , Singal Arbinder , Bhardwaj Shefali 
Published: May 2021

Abstract
Background/Objective: Patients with type 2 diabetes face challenges when it comes to following recommendations (nutrition, exercise and medications). Using technology to understand glycemic responses can increase patient awareness about dietary and lifestyle changes. Coupled with coaching by an expert nutritionist, such a program may help improve patient adherence, resulting in a reduction in HbA1c and body mass index (BMI). Method: Fifty-seven patients with type 2 DM not at goal (HbA1c ≥ 6.5%) either on lifestyle modification, OHA with or without insulin, consenting to participate in the study were enrolled in the DIABEFLY program which included Ambulatory glucose monitoring (AGM) and correlating it with dietary intake for 14 days using a technology platform (FITTERFLY wellness app). Patients were explained their AGM graphs, in relation to their daily food and activity log, to make them aware of their personalised glycemic responses to various foods and accordingly diet plan was suggested. Nutritionists (coaches) interacted with patients over calls on Day 1, 7, 14, 30, 60 and Day 90 to explain recommendations, address any diabetes related queries and evaluate adherence to diet & exercise plans. Patients also had access to daily chat support for 90 days and received daily messages on glycemic responses, healthy food choices, exercise options, stress management, sleep, medication adherence, self-monitoring of blood glucose and complications of diabetes. Strictly, no advice on type or dosage of medication was given by the coaches. Statistical analysis for outcomes was done by t-test using SPSS software.
Result: Out of 57 patients, mean age was 46 years, of which 70% were male and 30% were females. The baseline HbA1c was found to be 8.3% ± 1.68 which significantly decreased (p&lt;0.05) to 7.4% ± 1.36 in 3 months. The Baseline BMI of 27.1± 4.9 kg/ sq m was significantly reduced (p&lt;0.05) to 26.6±4.6 kg/sq m in 3 months.
Discussion: With the availability of AGM devices, powerful food databases and technology to correlate these two had led to a new era of diabetes coaching. The personalised glycemic responses so calculated for every patient lead to more concrete understanding of changes necessary for better glycemic control. Regular interactions or reminders from an expert may act as a unique and necessary way of reinforcement to follow recommendations. In our study, though increased engagement with the programme resulted in a significant reduction in HbA1c and BMI.
Conclusion: Personalized Glycemic response led coaching benefits patients with Type 2 diabetes mellitus helping them achieve two critical outcomes - lowering of HbA1c and reduction of BMI as early as three months.
Keywords: AGM; Personalised glycemic response; Diabetes lifestyle coaching