Effectiveness and Cost-Effectiveness of Fully-Automated Digital vs. Human Coach-Based Diabetes Prevention Programs

The purpose of this research study is to compare the effectiveness of a fully automated digital diabetes prevention program to standard of care human coach-based diabetes prevention programs for promoting clinically meaningful lifestyle changes to reduce the risk of type 2 diabetes in adults with prediabetes.

Study Overview

• Status: Completed
• Conditions: Hyperglycemia; Obesity; Overweight; Weight Loss; PreDiabetes; Prediabetic State; Impaired Glucose Tolerance; Glucose, High Blood; Lifestyle, Healthy; Lifestyle Risk Reduction; Lifestyle, Sedentary
• Intervention / Treatment: Behavioral: Human Coach-based Diabetes Prevention Program (hDPP); Behavioral: Digital Diabetes Prevention Program (dDPP)

Detailed Description

After being informed about the study and potential risk, all participants giving written informed consent will undergo screening to determine eligibility for study entry. At baseline visit (month 0). Participants who meet the eligibility requirements will be randomly assigned in 1:1 ratio to human coach-based diabetes prevention program or digital diabetes prevention program. An equal number of participants will be randomly assigned to both groups (like flipping a coin).

If participants are randomly assigned to receive the human coach-based diabetes prevention program, the participants will be referred to a local Diabetes Prevention Program close to the participants' area. The Diabetes Prevention Program consists of 16 weekly sessions during months 1 to 6 and 6 sessions during months 7 to 12. These group sessions may be delivered in-person at the local program or remotely using video conferencing. During these sessions, participants will receive information about lifestyle change behaviors focusing on weight loss, physical activity, and nutrition from a trained lifestyle coach.

If participants are randomly assigned to receive the digital Diabetes Prevention Program, the participants will receive the Sweetch Digital Health Kit (Sweetch Health, Ltd.) in the mail within approximately 8-12 days of the participants' first study visit. The Sweetch digital health kit consists of a smartphone app and a digital body weight scale that is connected via Bluetooth to the app. The phone app also consists of brief Centers for Disease Control and Prevention (CDC) lessons on type 2 diabetes prevention, which participants will be encouraged to complete.

There will be a total of 3 study visits (baseline, 6 months, and 12 months), each visit includes fingerstick hemoglobin A1C measurement, weight measurement, and completion of several questionnaires. Height will be measured at the first visit. Throughout the 12-month study, participants will be asked to wear a device on the participants' wrist to measure physical activity for 7 consecutive days following the first visit and once every month thereafter.

• Study Type: Interventional
• Enrollment (Actual): 368
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Baltimore, Maryland, United States, 21287
      • Johns Hopkins Hospital
  • Pennsylvania
    • Reading, Pennsylvania, United States, 19611
      • Reading Hospital - Tower Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Provision of signed and dated informed consent form.
• Stated willingness to comply with all study procedures and availability for the duration of the study.

• Laboratory evidence of prediabetes, defined as any of the following lab results, in the past year:

  1. Hemoglobin A1C 5.7% to 6.4%
  2. Fasting glucose 100-125 mg/dL
  3. Plasma glucose of 140-199 mg/dL measured 2 hours after a 75 gm glucose load
• Body mass index (BMI) ≥25 kg/m2 (or≥23 kg/m2 for Asians).
• Proficiency in reading English.
• Smartphone user (Android Operating System (OS) 9.0 or iOS 13.3 or newer).
• Plans to reside in recruitment area for the next 12 months (participant's zip code of residence is within ~45 miles of the study recruitment site.

Exclusion Criteria:

• Medical conditions that prevent adoption of moderate physical activity (per primary care clinician).
• Aortic stenosis.
• Unstable cardiac disease (myocardial infarction, heart failure, or stroke in previous 6 months, currently participating in cardiac rehabilitation).
• Has a pacemaker, implantable cardioverter-defibrillator (ICD), or other implanted electronic device.
• Use of any glucose-lowering medications, weight loss medications, or any systemic glucocorticoids within the previous 3 months.
• Active malignancy of any type or diagnosed with or treated for cancer within the past 2 years. Individuals with basal and squamous cell carcinoma of the skin that has been successfully treated will be allowed to participate.
• Diagnosis of diabetes mellitus.
• Pregnancy or planned pregnancy in the next 12 months.
• Anemia.
• Receiving treatment for iron-deficiency anemia, vitamin B12 deficiency, or folate d efficiency.
• Hemoglobinopathy (HbS or HbC disease).
• Blood transfusion in previous 4 months.
• On dialysis or active organ transplant list.
• Treated with erythropoietin.
• Major psychiatric disorder (schizophrenia) or use of antipsychotic medications within the past 1 year.
• Dementia or Alzheimer's disease.
• Diagnosed with an eating disorder (anorexia nervosa, avoidant/restrictive food intake disorder, binge eating disorder, bulimia nervosa, Pica, rumination disorder, other specified or unspecified feeding or eating disorder)
• Diagnosed or self-reported alcohol or substance abuse.
• Known allergy to steel.
• Participation in another clinical trial related to lifestyle management or diabetes prevention.
• Currently attending or attended a diabetes prevention program in the previous 2 years.
• Unwilling to accept random assignments.
• Had bariatric surgery within the 12 months prior randomization or is planning to undergo bariatric surgery during the study.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Fully-Automated Digital Diabetes Prevention Program; Participants will receive Sweetch Digital Diabetes Prevention Program consists of a smartphone app and bluetooth-enabled digital body weight scale that syncs with the app.	Behavioral: Digital Diabetes Prevention Program (dDPP); The Sweetch app is a hyper-personalized mobile digital coach that provides users with tailored recommendations to promote healthy lifestyle behaviors (150 minutes per week of physical activity, weight reduction, and healthy eating habits) to reduce the risk of type 2 diabetes. The Sweetch app uses self-tracking and multiple evidence-based persuasive eCoaching strategies. The Sweetch artificial intelligence algorithm delivers just-in-time support and/or adapt recommendations based on the user's response. For example, push notifications will be sent when the algorithm detects that the user is potentially available and able to act upon the recommendation, based on various parameters including location, previous response, calendar availability, and weather, etc.
Active Comparator: Human Coach-Based Diabetes Prevention Program; Participants will attend a total of 16 weekly sessions during months 1 to 6 and 6 sessions during months 7 to 12. These group sessions may be delivered in-person at the local program or remotely using video conferencing. During these sessions, participants will receive information about lifestyle change behaviors focusing on weight loss, physical activity, and nutrition from a trained lifestyle coach.	Behavioral: Human Coach-based Diabetes Prevention Program (hDPP); The Human Coach-Based Diabetes Prevention Program will consist of a CDC recognized lifestyle change program. Participants will attend a total of 16 weekly sessions during months 1 to 6 and 6 sessions during months 7 to 12. These group sessions may be delivered in-person at the local program or remotely using video conferencing. During these sessions, participants will receive information about lifestyle change behaviors focusing on weight loss, physical activity, and nutrition from a trained lifestyle coach.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Achievement of CDC's Benchmark for Type 2 Diabetes Risk Reduction as a Binary Outcome (Yes/no)	The primary outcome was the CDC-defined diabetes risk reduction benchmark at 12 months (based on the 2021 standards), defined as at least one of the following: Weight loss of ≥5%.; Weight loss of ≥4% combined with at least 150 weekly minutes of moderate-to-vigorous PA; An absolute decrease of ≥0.2 points in A1C (measured in %). The A1C endpoint was applicable only to participants with baseline A1C of 5.7% to 6.4%. Maintaining an A1C <6.5% throughout the study was also a criterion for the primary outcome.	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Absolute Weight Change	Absolute weight change (kilograms) from baseline to 12 months	At 12 months
Cost-effectiveness as Assessed by the Markov Model	The investigators will compare the cost-effectiveness of the two interventions based on lifetime horizon by constructing a Markov model with model parameters populated from the trial results as well as other published literature. The model will estimate the incremental cost-effectiveness ratio between the two interventions.	12 months
Change in Hemoglobin A1C	Change in HbA1C (percentage points) from baseline to 12 months (among participants with baseline HbA1C of 5.7% - 6.4% who completed the 12-month study visit).	At 12 months
Percentage Change in Weight	Percentage change in weight from baseline to 12 months	At 12 months
Mean Weekly Moderate-to-vigorous Physical Activity (MVPA)	Average minutes/week of physical activity assessed using blinded Actigraphy (monthly serial consecutive 7-days wear period). If the participant did not wear their monitor for at least 5 of their 7 assigned days, they were considered noncompliant. In this case, the participant was assigned 0 minutes for physical activity for that week.To obtain the average MVPA minutes per week across the study period, the total MVPA minutes per week from all valid wear periods were summed and divided by the number of available wear periods (maximum of 11 post-baseline visits). Specifically, activity intensity was classified as MVPA if the vector magnitude of accelerometer counts per minute was equal to or greater than 3941 (Montoye's cut point).	At 12 months
Incidence of Diabetes-range A1C	Number of individuals who had an AIC in the diabetes range (A1C ≥6.5%) at the 6-month or 12-month timepoint.	At either 6 or 12 months
Acceptability as Assessed by the 32-item Acceptability Questionnaire	To compare the acceptability of the two interventions (satisfaction, utility, interest, motivation, user experience, etc.) using the 32-item acceptability questionnaire. Scoring: Sum up all responses to questions 1-31, divide by 155 and multiply by 100 to calculate percentage score out of 100%. The range of possible scores is 20% (lowest acceptability) to 100% (highest possible acceptability).	12 months
Correlation Between Self-reported and Measured Physical Activity	To evaluate the correlation between self-reported PA data collected using different methods: Data collected and reported by hDPPs; Self-reported PA data collected by study team obtained at 1-month intervals; Objectively measured PA data (Actigraphy) obtained at 1-month intervals	6 months and 12 months
Program Initiation Rate	Program initiators were defined as participants who attended at least one in-person session (Human-DPP) or registered and used the Sweetch app (AI-DPP).	At 12 months
Program Completion Rate	Program completers attended ≥8 sessions in months 1-6 and spanned ≥9 months (Human-DPP), or engaged with the app for ≥8 weeks during months 1-6 with a span of ≥9 months between initiation and last engagement (AI-DPP).	At 12 months

Collaborators and Investigators

• Sponsor: Johns Hopkins University
• Collaborators: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Investigators: Principal Investigator: Nestoras Mathioudakis, MD MHS, Johns Hopkins University

Publications and helpful links

General Publications

• Mathioudakis N, Lalani B, Abusamaan MS, Alderfer M, Alver D, Dobs A, Kane B, McGready J, Riekert K, Ringham B, Shehadeh A, Vandi F, Wanigatunga AA, Zade D, Maruthur NM; AI-DPP Study Group. An AI-Powered Lifestyle Intervention vs Human Coaching in the Diabetes Prevention Program: A Randomized Clinical Trial. JAMA. 2025 Oct 27:e2519563. doi: 10.1001/jama.2025.19563. Online ahead of print.
• Abusamaan MS, Ballreich J, Dobs A, Kane B, Maruthur N, McGready J, Riekert K, Wanigatunga AA, Alderfer M, Alver D, Lalani B, Ringham B, Vandi F, Zade D, Mathioudakis NN. Effectiveness of artificial intelligence vs. human coaching in diabetes prevention: a study protocol for a randomized controlled trial. Trials. 2024 May 16;25(1):325. doi: 10.1186/s13063-024-08177-8.

Helpful Links

• Study Website

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2021
• Primary Completion (Actual): December 16, 2024
• Study Completion (Actual): December 16, 2024

Study Registration Dates

• First Submitted: September 14, 2021
• First Submitted That Met QC Criteria: September 23, 2021
• First Posted (Actual): September 24, 2021

Study Record Updates

• Last Update Posted (Estimated): December 17, 2025
• Last Update Submitted That Met QC Criteria: December 1, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Physical Activity; Obesity; Prediabetes; Overweight; Artificial Intelligence; Weight; Digital; DPP; Diabetes Prevention Program
• Additional Relevant MeSH Terms: Endocrine System Diseases; Nutrition Disorders; Metabolic Diseases; Overnutrition; Body Weight Changes; Glucose Metabolism Disorders; Diabetes Mellitus; Pathological Conditions, Signs and Symptoms; Behavior; Nutritional and Metabolic Diseases; Signs and Symptoms; Overweight; Obesity; Weight Loss; Body Weight; Hyperglycemia; Prediabetic State; Glucose Intolerance; Motor Activity; Sedentary Behavior; Risk Reduction Behavior
• Other Study ID Numbers: IRB00265873; 1R01DK125780-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The Data Coordinating Center (Johns Hopkins University) will prepare a de-identified database that is consistent with HIPAA requirements. The de-identified database will include all study research data and will be stored in a repository at Johns Hopkins University (archive.data.jhu.edu) at a time that will coincide with the online publication of the study primary endpoint paper. The repository will contain documentation designed to facilitate use of the database. The documentation prepared for the repository will include a list and timetable for secondary and exploratory papers planned by the study investigators. Access to the database will be restricted to qualified users. Qualified users will include those investigators who submit valid pre-specified hypotheses and certify that they will not use the data for commercial purposes.
• IPD Sharing Time Frame: The study protocol will be submitted for publication within 1 year of the start of enrollment.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

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