Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Jul 8;8(7):e17842.
doi: 10.2196/17842.

Mobile Delivery of the Diabetes Prevention Program in People With Prediabetes: Randomized Controlled Trial

Tatiana Toro-Ramos  1 , Andreas Michaelides  1 , Maria Anton  2 , Zulekha Karim  2 , Leah Kang-Oh  2 , Charalambos Argyrou  2 , Elisavet Loukaidou  2 , Marina M Charitou  2 , Wilson Sze  2 , Joshua D Miller  2
Affiliations
Randomized Controlled Trial

Mobile Delivery of the Diabetes Prevention Program in People With Prediabetes: Randomized Controlled Trial

Tatiana Toro-Ramos et al. JMIR Mhealth Uhealth. .

Abstract

Background: The Centers for Disease Control and Prevention (CDC) diabetes prevention program (DPP) has formed the foundation for Type 2 Diabetes Mellitus (T2DM) prevention efforts and lifestyle change modifications in multiple care settings. To our knowledge, no randomized controlled trial has verified the efficacy of a fully mobile version of CDC's diabetes prevention program (DPP).

Objective: This study aimed to investigate the long-term weight loss and glycemic efficacy of a mobile-delivered DPP compared with a control group receiving usual medical care.

Methods: Adults with prediabetes (N=202) were recruited from a clinic and randomized to either a mobile-delivered, coach-guided DPP (Noom) or a control group that received regular medical care including a paper-based DPP curriculum and no formal intervention. The intervention group learned how to use the Noom program, how to interact with their coach, and the importance of maintaining motivation. They had access to an interactive coach-to-participant interface and group messaging, daily challenges for behavior change, DPP-based education articles, food logging, and automated feedback. Primary outcomes included changes in weight and hemoglobin A1c (HbA1c) levels at 6 and 12 months, respectively. Exploratory secondary outcomes included program engagement as a predictor of changes in weight and HbA1c levels.

Results: A total of 202 participants were recruited and randomized into the intervention (n=101) or control group (n=99). In the intention-to-treat (ITT) analyses, changes in the participants' weight and BMI were significantly different at 6 months between the intervention and control groups, but there was no difference in HbA1c levels (mean difference 0.004%, SE 0.05; P=.94). Weight and BMI were lower in the intervention group by -2.64 kg (SE 0.71; P<.001) and -0.99 kg/m2 (SE 0.29; P=.001), respectively. These differences persisted at 12 months. However, in the analyses that did not involve ITT, program completers achieved a significant weight loss of 5.6% (SE 0.81; P<.001) at 6 months, maintaining 4.7% (SE 0.88; P<.001) of their weight loss at 12 months. The control group lost -0.15% at 6 months (SE 0.64; P=.85) and gained 0.33% (SE 0.70; P=.63) at 12 months. Those randomized to the intervention group who did not start the program had no meaningful weight or HbA1c level change, similar to the control group. At 1 year, the intervention group showed a 0.23% reduction in HbA1c levels; those who completed the intervention showed a 0.28% reduction. Those assigned to the control group had a 0.16% reduction in HbA1c levels.

Conclusions: This novel mobile-delivered DPP achieved significant weight loss reductions for up to 1 year compared with usual care. This type of intervention reduces the risk of overt diabetes without the added barriers of in-person interventions.

Trial registration: ClinicalTrials.gov NCT03865342; https://clinicaltrials.gov/ct2/show/NCT03865342.

Keywords: body weight; mHealth; mobile app; mobile phone; prediabetes; randomized controlled trial.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: TT and AM are employed by Noom, Inc and receive salary and stock options. AM holds a patent pending (3492.004US1) with Noom, Inc. Noom Coach is a mHealth program owned by Noom, Inc. The authors have no additional conflicts of interest, and no competing financial interests exist for the other authors.

Figures

Figure 1
Figure 1
Selection of screen pages for mobile health intervention.
Figure 2
Figure 2
Trial profile of recruitment and completion.
Figure 3
Figure 3
Weight change across time points. ITT: intention-to-treat; T0: baseline; T6: 6 months; T12: 12 months. ITT: intention-to-treat; T0: baseline; T6: 6 months; T12: 12 months.
Figure 4
Figure 4
BMI change across time points. ITT: intention-to-treat; T0: baseline; T6: 6 months; T12: 12 months.
Figure 5
Figure 5
Hemoglobin A1c change across time points. ITT: intention-to-treat; T0: baseline; T6: 6 months; T12: 12 months.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. CDC Centers for Disease Control and Prevention. 2017. [2020-05-07]. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States https://www.cdc.gov/diabetes/data/statistics/statistics-report.html.
    1. World Health Organization. 2016. [2019-03-28]. Global Report on Diabetes https://www.who.int/diabetes/global-report/en/:
    1. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010 Oct 22;8:29. doi: 10.1186/1478-7954-8-29. https://pophealthmetrics.biomedcentral.com/articles/10.1186/1478-7954-8-29 - DOI - DOI - PMC - PubMed
    1. American Diabetes Association Economic costs of diabetes in the US In 2017. Diabetes Care. 2018 May;41(5):917–28. doi: 10.2337/dci18-0007. http://europepmc.org/abstract/MED/29567642 - DOI - PMC - PubMed
    1. Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes. 2008 Apr 1;26(2):77–82. doi: 10.2337/diaclin.26.2.77. - DOI

Publication types

Associated data