WellStart Reboot Study

WellStart Type 2 Diabetes Study

This is a randomized, controlled comparison study that will evaluate the effectiveness of WellStart, a virtual intensive therapeutic lifestyle change program to control type 2 diabetes.

Study Overview

• Status: Withdrawn
• Conditions: Type 2 Diabetes Mellitus
• Intervention / Treatment: Behavioral: WellStart

Detailed Description

Purpose: To test the efficacy of WellStart Health program to to arrest and / or reverse type 2 diabetes.

Future comparative studies between programs programs are anticipated, utilizing this data to help identify the strengths and weaknesses of different programs, as well as identify subpopulations that might benefit from one program as opposed to another.

Data from this study will be shared via posters and papers among the lifestyle medicine community / publications to help contribute to better lifestyle interventions.

Pilot programs reported on the WellStart web page report reduction in hemoglobin A1c (HBA1c) and weight during the 12 week program.

The web site states:

Evidence for the Program:

The 12-week lifestyle medicine program provides online health coaching and education on 5 domains of wellbeing: whole food, plant-forward nutrition, movement, mindset and social support and resilience. The pilot programs have shown a mean weight reduction of 6.9 lbs in 85% of participants of the 12-week program. 85% of participants with prediabetes experienced a reduction in hemoglobin A1c, while 100% of those with diabetes had a mean hemoglobin A1c reduction of 1.1. WellStart has also helped 35% of participants on pharmacotherapy, eliminate medication (antihypertensives and metformin).

Studies have shown the ability of plant-based nutrition to reverse chronic disease including coronary artery disease. The BROAD study found a statistically significant reduction in BMI and cholesterol in those following a plant-based diet. Furthermore, Dean Ornish's research showed regression of coronary atherosclerosis after 5 years of a plant-based diet in addition to lifestyle changes and found that it reduced cardiac events by half. Caldwell Esselstyn's research on a whole food plant-based diet also demonstrated a significant reduction in major cardiac events in adherent patients.

Furthermore, a 2016 comprehensive literature review supports a plant-based diet as medical nutrition therapy for diabetes based on its ability to reduce fasting blood glucose, hemoglobin A1c, body mass index and reduce medication use.

The Diabetes Prevention Program (DPP), a lifestyle and diet intervention program, reduces the risk of diabetes by half in a population at risk. It has been successfully adapted to the online setting. WellStart is taking this concept a step further by providing participants with additional education and support to transition to plant-forward nutrition habits.

• Study Type: Interventional
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Ohio
    • Athens, Ohio, United States, 45701
      • Ohio University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Established diagnosis of type 2 diabetes (T2DM)
• Between the ages of 18 and 65 years-old
• Own and willing to use a smart phone or computer, and have daily internet access
• Have an email account
• Have access to resources (finances and transportation) that allow for regular acquisition (at least once weekly) of groceries, including produce
• Access to resources that allow for food preparation at home (refrigeration, basic kitchen appliances and supplies)
• Willingness to attempt changes in food preparation and consumption, and physical activity.

-Scoring at least a 7/10 in both readiness for change and confidence of success; 1= not ready / no confidence; 10 = extremely ready / extremely confident of success -

Exclusion Criteria:

• Dementia
• Advanced renal disease (stage 4 or 5) with or without hemodialysis
• Congestive Heart Failure
• Taking warfarin
• Pregnancy or plans for pregnancy
• Current smoker of tobacco cigarettes
• Adults who have a physical limitation to prepare their own food or incorporate movement into their lifestyle (based on questionnaire answer)
• Brittle diabetes and/or history of hospitalization for high or low blood sugar
• Difficult-to-control hypertension and / or on 4 or more medications for high blood pressure.
• Does not speak or understand English
• Inability to use email or the Internet

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: WellStart; WellStart is a 12-week virtual intensive therapeutic lifestyle program utilizing web-based encounters with physicians, dietitians, health coaches and additional resources.	Behavioral: WellStart; Five weekly automated text messages linked to an online article on health and wellness.; Five weekly automated health coach motivational text message to smart phone. Optional back and forth text with their health coach is available.; Daily Option to participate and post comments or questions in online discussion forum moderated by health coaches.; Three group (up to 20 participants) health coach online visits (60 minutes).; Two online group visits with a dietitian in groups of 10-12 participants.; Three one-on-one online visits with a Physician Advisor to review progress, review any changes in medications by the primary medical provider (PCP), review biometrics and lab results, review safety guidelines and symptoms (30 minutes).
No Intervention: Usual Care; The control group will continue with usual care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hemoglobin A1c	glycosylated hemoglobin, measure of diabetes control over last 3 months	6 months
Weight	risk factor for diabetes	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Short Form Health Survey - 36 Questions (SF-36)	Survey of patient health status	6 months
Total cholesterol	risk factor for cardiovascular disease, a comorbidity of diabetes	6 months
Low density lipoprotein cholesterol (calculated)	risk factor for cardiovascular disease, a comorbidity of diabetes	6 months
High density lipoprotein cholesterol	risk factor for cardiovascular disease, a comorbidity of diabetes	6 months
Triglycerides	risk factor for cardiovascular disease, a comorbidity of diabetes	6 months
Systolic Blood Pressure	risk factor for cardiovascular disease, a comorbidity of diabetes	6 months
Diastolic Blood Pressure	risk factor for cardiovascular disease, a comorbidity of diabetes	6 months
Days per week of exercise	Average days per week of exercise, self reported by patient	6 months
Minutes per day of exercise	Average minutes per day of exercise, self reported by patient	6 months

Collaborators and Investigators

• Sponsor: Ohio University

Publications and helpful links

General Publications

• Song M, Fung TT, Hu FB, Willett WC, Longo VD, Chan AT, Giovannucci EL. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. JAMA Intern Med. 2016 Oct 1;176(10):1453-1463. doi: 10.1001/jamainternmed.2016.4182. Erratum In: JAMA Intern Med. 2016 Nov 1;176(11):1728.
• Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7. doi: 10.1001/jama.280.23.2001. Erratum In: JAMA 1999 Apr 21;281(15):1380.
• Esselstyn CB Jr. Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). Am J Cardiol. 1999 Aug 1;84(3):339-41, A8. doi: 10.1016/s0002-9149(99)00290-8.
• Diabetes Prevention Program Research Group; Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009 Nov 14;374(9702):1677-86. doi: 10.1016/S0140-6736(09)61457-4. Epub 2009 Oct 29. Erratum In: Lancet. 2009 Dec 19;374(9707):2054.

Helpful Links

• WellStart web site (intervention)

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2018
• Primary Completion (Actual): December 1, 2018
• Study Completion (Actual): December 1, 2018

Study Registration Dates

• First Submitted: October 31, 2018
• First Submitted That Met QC Criteria: November 2, 2018
• First Posted (Actual): November 6, 2018

Study Record Updates

• Last Update Posted (Actual): September 16, 2020
• Last Update Submitted That Met QC Criteria: September 15, 2020
• Last Verified: February 1, 2020

More Information

Terms related to this study

• Keywords: diabetes; exercise; nutrition; lifestyle
• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Diabetes Mellitus; Diabetes Mellitus, Type 2
• Other Study ID Numbers: 18-X-292

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No