A Fully Automated Web-Based Program Improves Lifestyle Habits and HbA1c in Patients With Type 2 Diabetes and Abdominal Obesity: Randomized Trial of Patient E-Coaching Nutritional Support (The ANODE Study)

Boris Hansel, Philippe Giral, Laetitia Gambotti, Alexandre Lafourcade, Gilbert Peres, Claude Filipecki, Diana Kadouch, Agnes Hartemann, Jean-Michel Oppert, Eric Bruckert, Michel Marre, Arnaud Bruneel, Emilie Duchene, Ronan Roussel, Boris Hansel, Philippe Giral, Laetitia Gambotti, Alexandre Lafourcade, Gilbert Peres, Claude Filipecki, Diana Kadouch, Agnes Hartemann, Jean-Michel Oppert, Eric Bruckert, Michel Marre, Arnaud Bruneel, Emilie Duchene, Ronan Roussel

Abstract

Background: The prevalence of abdominal obesity and type 2 diabetes mellitus (T2DM) is a public health challenge. New solutions need to be developed to help patients implement lifestyle changes.

Objective: The objective of the study was to evaluate a fully automated Web-based intervention designed to help users improve their dietary habits and increase their physical activity.

Methods: The Accompagnement Nutritionnel de l'Obésité et du Diabète par E-coaching (ANODE) study was a 16-week, 1:1 parallel-arm, open-label randomized clinical trial. Patients with T2DM and abdominal obesity (n=120, aged 18-75 years) were recruited. Patients in the intervention arm (n=60) had access to a fully automated program (ANODE) to improve their lifestyle. Patients were asked to log on at least once per week. Human contact was limited to hotline support in cases of technical issues. The dietetic tool provided personalized menus and a shopping list for the day or the week. Stepwise physical activity was prescribed. The control arm (n=60) received general nutritional advice. The primary outcome was the change of the dietary score (International Diet Quality Index; DQI-I) between baseline and the end of the study. Secondary endpoints included changes in body weight, waist circumference, hemoglobin A1c (HbA1c) and measured maximum oxygen consumption (VO2 max).

Results: The mean age of the participants was 57 years (standard deviation [SD] 9), mean body mass index was 33 kg/m² (SD 4), mean HbA1c was 7.2% (SD 1.1), and 66.7% (80/120) of participants were women. Using an intention-to-treat analysis, the DQI-I score (54.0, SD 5.7 in the ANODE arm; 52.8, SD 6.2 in the control arm; P=.28) increased significantly in the ANODE arm compared to the control arm (+4.55, SD 5.91 vs -1.68, SD 5.18; between arms P<.001). Body weight, waist circumference, and HbA1c changes improved significantly in the intervention.

Conclusions: Among patients with T2DM and abdominal obesity, the use of a fully automated Web-based program resulted in a significant improvement in dietary habits and favorable clinical and laboratory changes. The sustainability of these effects remains to be determined.

Trial registration: ClinicalTrials.gov NCT02343107; https://ichgcp.net/clinical-trials-registry/NCT02343107 (Archived by WebCite at http://www.webcitation.org/6uVMKPRzs).

Keywords: e-health; nutrition; type 2 diabetes.

Conflict of interest statement

Conflicts of Interest: BH was a consultant for MXS between 2009 and 2011. No other authors declare conflicts of interest.

©Boris Hansel, Philippe Giral, Laetitia Gambotti, Alexandre Lafourcade, Gilbert Peres, Claude Filipecki, Diana Kadouch, Agnes Hartemann, Jean-Michel Oppert, Eric Bruckert, Michel Marre, Arnaud Bruneel, Emilie Duchene, Ronan Roussel. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 08.11.2017.

Figures

Figure 1
Figure 1
Study design.
Figure 2
Figure 2
Flowchart of the study.
Figure 3
Figure 3
Percentage of patients in the intervention and control arms achieving weight loss >3%, >5% or >10% at 16-week follow-up, in the intention-to-treat population. *P<.05 between intervention and control arms.>

References

    1. World Health Organization. 2016. [2017-09-27]. Global report on diabetes .
    1. Lim S, Meigs JB. Ectopic fat and cardiometabolic and vascular risk. Int J Cardiol. 2013 Nov 05;169(3):166–76. doi: 10.1016/j.ijcard.2013.08.077.
    1. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR, American Diabetes Association (ADA) European Association for the Study of Diabetes (EASD) Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Diabetes Care. 2012 Jun;35(6):1364–79. doi: 10.2337/dc12-0413.
    1. Ramadas A, Quek KF, Chan CK, Oldenburg B. Web-based interventions for the management of type 2 diabetes mellitus: a systematic review of recent evidence. Int J Med Inform. 2011 Jun;80(6):389–405. doi: 10.1016/j.ijmedinf.2011.02.002.
    1. Noh J, Cho Y, Nam H, Kim J, Kim D, Yoo H, Kwon Y, Woo M, Cho J, Hong M, Yoo J, Gu M, Kim S, An K, Jang S, Kim E, Yoo H. Web-based comprehensive information system for self-management of diabetes mellitus. Diabetes Technol Ther. 2010 May;12(5):333–7. doi: 10.1089/dia.2009.0122.
    1. Agboola S, Jethwani K, Lopez L, Searl M, O'Keefe S, Kvedar J. Text to move: a randomized controlled trial of a text-messaging program to improve physical activity behaviors in patients with type 2 diabetes mellitus. J Med Internet Res. 2016 Nov 18;18(11):e307. doi: 10.2196/jmir.6439.
    1. Castetbon K, Vernay M, Malon A, Salanave B, Deschamps V, Roudier C, Oleko A, Szego E, Hercberg S. Dietary intake, physical activity and nutritional status in adults: the French nutrition and health survey (ENNS, 2006-2007) Br J Nutr. 2009 Sep;102(5):733–43. doi: 10.1017/S0007114509274745.
    1. Lassale C, Castetbon K, Laporte F, Camilleri GM, Deschamps V, Vernay M, Faure P, Hercberg S, Galan P, Kesse-Guyot E. Validation of a Web-based, self-administered, non-consecutive-day dietary record tool against urinary biomarkers. Br J Nutr. 2015 Mar 28;113(6):953–62. doi: 10.1017/S0007114515000057.
    1. Touvier M, Kesse-Guyot E, Méjean C, Pollet C, Malon A, Castetbon K, Hercberg S. Comparison between an interactive web-based self-administered 24 h dietary record and an interview by a dietitian for large-scale epidemiological studies. Br J Nutr. 2011 Apr;105(7):1055–64. doi: 10.1017/S0007114510004617.
    1. Lassale C, Galan P, Julia C, Fezeu L, Hercberg S, Kesse-Guyot E. Association between adherence to nutritional guidelines, the metabolic syndrome and adiposity markers in a French adult general population. PLoS One. 2013;8(10):e76349. doi: 10.1371/journal.pone.0076349.
    1. Kim S, Haines PS, Siega-Riz AM, Popkin BM. The Diet Quality Index-International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. J Nutr. 2003 Nov;133(11):3476–84.
    1. Martin A, AFSSA . Apports nutritionnels conseillés pour la population française. 3ème édition. France: Lavoisier; 2001. pp. 1–605.
    1. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003 Aug;35(8):1381–95. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. ACSM's Guidelines for Exercise Testing and Prescription. Alphen aan den Rijn, Netherlands: Wolters Kluwer; 2013. Feb 13, WilliamsWilkins: Baltimore, MD.
    1. Su D, Zhou J, Kelley MS, Michaud TL, Siahpush M, Kim J, Wilson F, Stimpson JP, Pagán JA. Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 randomized controlled trials. Diabetes Res Clin Pract. 2016 Jun;116:136–48. doi: 10.1016/j.diabres.2016.04.019.
    1. Cotter AP, Durant N, Agne AA, Cherrington AL. Internet interventions to support lifestyle modification for diabetes management: a systematic review of the evidence. J Diabetes Complications. 2014;28(2):243–51. doi: 10.1016/j.jdiacomp.2013.07.003.
    1. Lorig K, Ritter PL, Laurent DD, Plant K, Green M, Jernigan VB, Case S. Online diabetes self-management program: a randomized study. Diabetes Care. 2010 Jun;33(6):1275–81. doi: 10.2337/dc09-2153.
    1. Glasgow RE, Kurz D, King D, Dickman JM, Faber AJ, Halterman E, Woolley T, Toobert DJ, Strycker LA, Estabrooks PA, Osuna D, Ritzwoller D. Twelve-month outcomes of an Internet-based diabetes self-management support program. Patient Educ Couns. 2012 Apr;87(1):81–92. doi: 10.1016/j.pec.2011.07.024.
    1. Carter EL, Nunlee-Bland G, Callender C. A patient-centric, provider-assisted diabetes telehealth self-management intervention for urban minorities. Perspect Health Inf Manag. 2011;8:1b.
    1. McIlhenny CV, Guzic BL, Knee DR, Wendekier CM, Demuth BR, Roberts JB. Using technology to deliver healthcare education to rural patients. Rural Remote Health. 2011;11(4):1798.
    1. McKay HG, King D, Eakin EG, Seeley JR, Glasgow RE. The diabetes network internet-based physical activity intervention: a randomized pilot study. Diabetes Care. 2001 Aug;24(8):1328–34.
    1. Turnin MC, Bourgeois O, Cathelineau G, Leguerrier AM, Halimi S, Sandre-Banon D, Coliche V, Breux M, Verlet E, Labrousse F, Bensoussan D, Grenier JL, Poncet MF, Tordjmann F, Brun JM, Blickle JF, Mattei C, Bolzonella C, Buisson JC, Fabre D, Tauber JP, Hanaire-Broutin H. Multicenter randomized evaluation of a nutritional education software in obese patients. Diabetes Metab. 2001 Apr;27(2 Pt 1):139–47.
    1. Raaijmakers LC, Pouwels S, Berghuis KA, Nienhuijs SW. Technology-based interventions in the treatment of overweight and obesity: a systematic review. Appetite. 2015 Dec;95:138–51. doi: 10.1016/j.appet.2015.07.008.
    1. Tanaka M, Adachi Y, Adachi K, Sato C. Effects of a non-face-to-face behavioral weight-control program among Japanese overweight males: a randomized controlled trial. Int J Behav Med. 2010 Mar;17(1):17–24. doi: 10.1007/s12529-009-9057-1.
    1. Tate DF, Jackvony EH, Wing RR. A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Arch Intern Med. 2006;166(15):1620–5. doi: 10.1001/archinte.166.15.1620.
    1. National Institute for Health and Care Excellence Public Health Draft Guideline. 2011. [2017-09-26]. Maintaining a healthy weight and preventing excess weight gain among children and adults .
    1. Astrand PO, Rodahl K, Dahl HA, Stromme SB. Textbook of Work Physiology: Physiological Bases of Exercise, Fourth Edition. Champaign, IL: Human Kinetics; 2003.
    1. Bouchard C, Blair SN, Katzmarzyk PT. Less sitting, more physical activity, or higher fitness? Mayo Clin Proc. 2015 Nov;90(11):1533–40. doi: 10.1016/j.mayocp.2015.08.005.
    1. Flores MG, Granado-Font E, Ferré-Grau C, Montaña-Carreras X. Mobile phone apps to promote weight loss and increase physical activity: a systematic review and meta-analysis. J Med Internet Res. 2015;17(11):e253. doi: 10.2196/jmir.4836.
    1. Laing BY, Mangione CM, Tseng C, Leng M, Vaisberg E, Mahida M, Bholat M, Glazier E, Morisky DE, Bell DS. Effectiveness of a smartphone application for weight loss compared with usual care in overweight primary care patients: a randomized, controlled trial. Ann Intern Med. 2014 Nov 18;161(10 Suppl):S5–12. doi: 10.7326/M13-3005.
    1. Partridge SR, McGeechan K, Hebden L, Balestracci K, Wong AT, Denney-Wilson E, Harris MF, Phongsavan P, Bauman A, Allman-Farinelli M. Effectiveness of a mHealth lifestyle program with telephone support (TXT2BFiT) to prevent unhealthy weight gain in young adults: randomized controlled trial. JMIR Mhealth Uhealth. 2015;3(2):e66. doi: 10.2196/mhealth.4530.
    1. Jennings CA, Vandelanotte C, Caperchione CM, Mummery WK. Effectiveness of a web-based physical activity intervention for adults with type 2 diabetes-a randomised controlled trial. Prev Med. 2014 Mar;60:33–40. doi: 10.1016/j.ypmed.2013.12.011.
    1. Rzewnicki R, Vanden AY, De BI. Addressing overreporting on the International Physical Activity Questionnaire (IPAQ) telephone survey with a population sample. Public Health Nutr. 2003 May;6(3):299–305. doi: 10.1079/PHN2002427.
    1. Vandelanotte C, Spathonis KM, Eakin EG, Owen N. Website-delivered physical activity interventions a review of the literature. Am J Prev Med. 2007 Jul;33(1):54–64. doi: 10.1016/j.amepre.2007.02.041.
    1. Davies CA, Spence JC, Vandelanotte C, Caperchione CM, Mummery WK. Meta-analysis of internet-delivered interventions to increase physical activity levels. Int J Behav Nutr Phys Act. 2012;9:52. doi: 10.1186/1479-5868-9-52.

Source: PubMed

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