The influence of baseline A1c on digital health coaching outcomes for adults with type 2 diabetes: A real-world retrospective cohort study (Preprint)

BACKGROUND Digital health coaching is an increasingly common diabetes self-management support strategy for individuals with type 2 diabetes and has been linked to positive mental and physical health outcomes. However, the relationship between baseline risk and outcomes has yet to be evaluated in a real-world setting. OBJECTIVE The purpose of this real-world study was to evaluate trends in digital health coaching outcomes by baseline A1c to better understand which populations may experience the greatest clinical and psychosocial benefit. METHODS A retrospective cohort study design was used to evaluate program effect in a convenience sample of participants in a 12-week digital health coaching program, administered by Pack Health. Participants were referred through their healthcare provider, payer, or employer. The program included patient-centered lifestyle counseling and psychosocial support delivered via telephone, text and/or email. Self-reported A1c and weight were collected at baseline and completion. Physical and mental health were assessed using the PROMIS Global Health short form and the Diabetes Distress Scale-2. Changes in Alc, weight, BMI, physical and mental health were analyzed within three participant cohorts stratified by baseline A1c level. RESULTS Participants with complete A1c datasets (n=226) were included in the analysis. Participants were 72% female, with 62% identifying as white and 34% as black. Most participants (81%) reported a baseline A1c ≥ 7%, and 20% were classified as high-risk (A1c > 9%). Across A1c cohorts, the average baseline BMI was 35.83 (SD=7.79), and the moderate risk cohort (7% ≤ A1c ≤ 9%) reported the highest average (36.6; SD=7.79). At 12 weeks, patients reported a significant decrease in Alc, and high-risk participants reduced their levels by the greatest margin (2.28 points; P<.001). Across cohorts, BMI improved by 0.82 (P<.001), with the moderate risk cohort showing the greatest reduction (-0.88; P<.001). Overall, participants reported significant improvements for PROMIS scores, with the greatest change occurring in the high-risk cohort for whom physical health improved 3.84 points (P<.001) and mental health improved 3.3 points (P<.001). However, the lowest risk cohort showed the greatest improvements in diabetes distress (-0.76; P<.005). CONCLUSIONS Acknowledging the limitations in this real-world study design, the results reported here suggest that adults with type 2 diabetes with a high baseline A1c or high BMI may benefit the most from patient-centered digital health coaching programs when compared to their lower risk counterparts. While all participants improved in physical and mental health categories, participants with high A1c experienced the greatest A1c reduction and individuals with the highest baseline BMI lost the most weight. These results may be used to inform referrals for patients who are more likely to benefit from digital health coaching. CLINICALTRIAL