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Improved glycemic control among individuals with diabetes who used a digital, personalized nutrition platform: Longitudinal study (Preprint)


 BACKGROUND
 Diabetes has the highest cost across all chronic conditions in the United States, with type 2 diabetes accounting for up to 95% of all cases. Diabetes affects most of the body’s organ systems and can lead to the development of comorbidities such as cardiovascular and kidney disease. A healthy diet is strongly associated with lowering HbA1c levels among individuals with diabetes, which can help curtail other health complications. Digital health platforms can offer critical support in improving diet and glycemic control among individuals with diabetes.
 
 
 OBJECTIVE
 To characterize Foodsmart users with diabetes and evaluate the longitudinal impact of Foodsmart, a digital, personalized nutrition platform with meal planning, food ordering, and nutrition education features, on changes in HbA1c levels.
 
 
 METHODS
 We included 643 adults with at least two self-reported HbA1c entries in the Foodsmart platform between January 2016 and June 2021. Participants self-reported their HbA1c levels, height, weight, health conditions, and dietary habits in a 53-item food frequency questionnaire on the platform. Diabetes was defined as HbA1c ≥ 6.5%. We analyzed distributions of characteristics by baseline diabetes status, and examined the association of characteristics with the likelihood of having diabetes at baseline. We calculated mean changes (absolute and percent) in HbA1c among participants with diabetes and by length of follow-up. We also compared changes in HbA1c and weight between participants with diabetes at baseline who achieved a normal HbA1c level and those who did not.
 
 
 RESULTS
 We found that 43.5% (280/643) of the participants with at least two HbA1c level entries had diabetes at baseline. Participants with diabetes at baseline were more likely to be male, have a higher weight, higher BMI, report high blood pressure, and have a lower baseline Nutriscore in comparison to participants without diabetes. Using a multivariable logistic regression model, we found that being male and obese were statistically significantly associated with baseline diabetes. Among participants with diabetes at baseline, HbA1c had an absolute reduction, on average, of -0.47%. 21.6% (60/280) of participants with diabetes achieved a normal HbA1c level (<6.5%) in their last HbA1c level entry; this percentage increased with longer follow-up time (38.9% at >24 months). In a sensitivity analysis, users with an HbA1c ≥ 7.0% at baseline had an absolute change of -0.62%, on average, and 31.2% (62/199) of these participants also achieved HbA1c levels of less than 7.0%.
 
 
 CONCLUSIONS
 This study assessed characteristics of individuals enrolled on the Foodsmart platform with HbA1c levels and found that users with diabetes improved HbA1c levels over time and a sizable percentage of participants were successful in achieving normal levels. Thus, the Foodsmart platform may be a cost-effective option in managing diabetes.
