Effectiveness of Non-Contact Dietary Coaching in Adults with Diabetes or Prediabetes Using a Continuous Glucose Monitoring Device: A Randomized Controlled Trial.

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• Approximately 26% of adults aged 30 years have impaired glucose metabolism and the proportion of this patient group is increasing rapidly worldwide.
• For patients with prediabetes, early detection and prompt intervention are important, as the condition may be reversible through dietary and lifestyle changes.
• This randomised-controlled trial suggests favourable changes in male thigh circumference and female eating self-efficiency in patients with diabetes and prediabetes who receive advanced dietary coaching while using a CGM system.

Introduction

A randomised-control trial was conducted to evaluate the effectiveness of continuous glucose monitoring (CGM) with dietary coaching on behavioral skills and health outcomes in patients with diabetes or prediabetes.

Method

45 Male and female participants aged 18-70 years were divided into control (n=23) and experimental groups (n=22). The control group received conventional care and education on physical activity and medication compliance at the start of the treatment and after two weeks. Behavioral skills and health outcomes were assessed after four weeks. The experimental group received conventional care and a non-contact, nurse-led dietary coaching program, consisting of education, and dietary feedback with individual and group coaching. For 4 weeks, education was conducted every Monday, dietary feedback and individual coaching were conducted daily and group coaching was conducted every Thursday.

A Weight Efficacy Lifestyle Short-Form questionnaire was used to assess weight efficacy. Depression was measured using the Patient Health Questionnaire-2. A 4-item Mini-Sleep Questionnaire was used to assess the presence of insomnia. Anthropometric parameters were BMI and waist and thigh circumferences. HbA1c level, apolipoprotein B (ApoB)/apolipoprotein A (ApoA) ratio, and the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) were measured.

Results

• There was no significant difference in Body Mass Index (BMI), waist circumference, HbA1c levels, ApoB/ApoA ratio, or HOMA-IR scores between the experimental and control groups.
• There was a significant difference in male thigh circumference between the control and experimental groups (z = -2.02, p = 0.044, effect size = 0.255).
• The female participants showed a significant improvement in eating self-efficacy (adhering to one’s dietary plan and limiting calorie intake) in the experimental group compared to the control group after the intervention (z = -2.66, p = 0.008, effect size = 0.262).
• There were no significant differences observed in the health outcomes: depression, insomnia, BMI, waist circumference, HbA1c levels, ApoB/ApoA ratio, or HOMA-IR score.

Conclusion

This randomised-control trial reported that a non-contact dietary coaching program influenced changes in diabetic and prediabetic male participants’ thigh circumference and female participants’ eating self-efficacy.

• Conventional care and patient education play an important role in managing the health outcomes of diabetic patients.
• The CGM is useful for practitioners and patients to provide biofeedback, monitor dietary adherence, and assess glycaemic variability.
• Even if conducted through non-contact methods, dietary coaching programs may still be useful to enhance behavioural skills, such as eating self-efficacy in diabetic and prediabetic patients using CGM.

• This study investigated the effectiveness of the GROW (goal, reality, options and will) model dietary coaching program on behaviour skills and health outcomes in diabetic and prediabetic patients over 4 weeks.
• Further research is needed to develop advanced dietary coaching programs over longer periods to assess there efficacy in diabetic and prediabetic patients using CGM.