PMID- 33325831 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220224 IS - 2371-4379 (Electronic) IS - 2371-4379 (Linking) VI - 5 IP - 4 DP - 2020 Dec 16 TI - Continuous Glucose Monitoring With Low-Carbohydrate Diet Coaching in Adults With Prediabetes: Mixed Methods Pilot Study. PG - e21551 LID - 10.2196/21551 [doi] LID - e21551 AB - BACKGROUND: Type 2 diabetes mellitus (T2DM) is preventable; however, few patients with prediabetes participate in prevention programs. The use of user-friendly continuous glucose monitors (CGMs) with low-carbohydrate diet coaching is a novel strategy to prevent T2DM. OBJECTIVE: This study aims to determine the patient satisfaction and feasibility of an intervention combining CGM use and low-carbohydrate diet coaching in patients with prediabetes to drive dietary behavior change. METHODS: We conducted a mixed methods, single-arm pilot and feasibility study at a suburban family medicine clinic. A total of 15 adults with prediabetes with hemoglobin A(1c) (HbA(1c)) levels between 5.7% and 6.4% and a BMI >30 kg/m(2) were recruited to participate. The intervention and assessments took place during 3 in-person study visits and 2 qualitative phone interviews (3 weeks and 6 months after the intervention). During visit 1, participants were asked to wear a CGM and complete a food intake and craving log for 10 days. During visit 2, the food intake and craving log along with the CGM results of the participants were reviewed and the participants received low-carbohydrate diet coaching, including learning about carbohydrates and personalized feedback. A second CGM sensor, with the ability to scan and record glucose trends, was placed, and the participants logged their food intake and cravings as they attempted to reduce their total carbohydrate intake (<100 g/day). During visit 3, the participants reviewed their CGM and log data. The primary outcome was satisfaction with the use of CGM and low-carbohydrate diet. The secondary outcomes included feasibility, weight, and HbA(1c) change, and percentage of time spent in hyperglycemia. Changes in attitudes and risk perception of developing diabetes were also assessed. RESULTS: The overall satisfaction rate of our intervention was 93%. The intervention induced a weight reduction of 1.4 lb (P=.02) and a reduction of HbA(1c) levels by 0.71% (P<.001) since enrollment. Although not significantly, the percentage of time above glucose goal and average daily glucose levels decreased slightly during the study period. Qualitative interview themes indicated no major barriers to CGM use; the acceptance of a low-carbohydrate diet; and that CGMs helped to visualize the impact of carbohydrates on the body, driving dietary changes. CONCLUSIONS: The use of CGMs and low-carbohydrate diet coaching to drive dietary changes in patients with prediabetes is feasible and acceptable to patients. This novel method merits further exploration, as the preliminary data indicate that combining CGM use with low-carbohydrate diet coaching drives dietary changes, which may ultimately prevent T2DM. CI - (c)Olivia Yost, Melissa DeJonckheere, Spring Stonebraker, Grace Ling, Lorraine Buis, Rodica Pop-Busui, Noa Kim, Kara Mizokami-Stout, Caroline Richardson. Originally published in JMIR Diabetes (http://diabetes.jmir.org), 16.12.2020. FAU - Yost, Olivia AU - Yost O AUID- ORCID: 0000-0002-3922-1543 AD - Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States. FAU - DeJonckheere, Melissa AU - DeJonckheere M AUID- ORCID: 0000-0002-2660-3358 AD - Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States. AD - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States. FAU - Stonebraker, Spring AU - Stonebraker S AUID- ORCID: 0000-0002-0277-6801 AD - Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States. FAU - Ling, Grace AU - Ling G AUID- ORCID: 0000-0002-3755-5101 AD - Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States. FAU - Buis, Lorraine AU - Buis L AUID- ORCID: 0000-0001-5855-9972 AD - Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States. AD - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States. FAU - Pop-Busui, Rodica AU - Pop-Busui R AUID- ORCID: 0000-0002-2042-1350 AD - Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States. FAU - Kim, Noa AU - Kim N AUID- ORCID: 0000-0002-3033-9641 AD - Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States. FAU - Mizokami-Stout, Kara AU - Mizokami-Stout K AUID- ORCID: 0000-0002-6933-2586 AD - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States. AD - Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States. FAU - Richardson, Caroline AU - Richardson C AUID- ORCID: 0000-0002-1305-4134 AD - Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States. AD - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States. LA - eng GR - P30 DK020572/DK/NIDDK NIH HHS/United States GR - P30 DK092926/DK/NIDDK NIH HHS/United States PT - Journal Article DEP - 20201216 PL - Canada TA - JMIR Diabetes JT - JMIR diabetes JID - 101719410 PMC - PMC7773517 OTO - NOTNLM OT - blood glucose self-monitoring OT - diet modification OT - low carbohydrate diet OT - prediabetes OT - prevention & control OT - type 2 diabetes mellitus COIS- Conflicts of Interest: A research discount was provided on CGMs by Abbott. Our team currently has other research projects funded by industry partners, including Apple and Dexcom. EDAT- 2020/12/17 06:00 MHDA- 2020/12/17 06:01 PMCR- 2020/12/16 CRDT- 2020/12/16 12:10 PHST- 2020/06/19 00:00 [received] PHST- 2020/10/26 00:00 [accepted] PHST- 2020/09/21 00:00 [revised] PHST- 2020/12/16 12:10 [entrez] PHST- 2020/12/17 06:00 [pubmed] PHST- 2020/12/17 06:01 [medline] PHST- 2020/12/16 00:00 [pmc-release] AID - v5i4e21551 [pii] AID - 10.2196/21551 [doi] PST - epublish SO - JMIR Diabetes. 2020 Dec 16;5(4):e21551. doi: 10.2196/21551.