Improved Metabolic Outcomes in Individuals with Type 2 Diabetes and Nonalcoholic Fatty Liver Disease after a Digital Intervention

Nonalcoholic fatty liver disease (NAFLD) is a common comorbidity among individuals with type 2 diabetes mellitus (T2DM). The aim of this study was to test the feasibility and efficacy of a digital intervention to improve metabolic outcomes for patients with T2DM and NAFLD. A single-arm study was conducted in Iceland. Participants were provided with a 12-week digital behavioral intervention via the Sidekick app, focused on health education and lifestyle coaching, reducing carbohydrate intake, increasing physical activity, and improving mental health. Individuals with NAFLD and either BMI>30, metabolic syndrome, or T2DM were recruited; here we present a sub-analysis of participants with T2DM. The primary outcome was feasibility, as measured by user retention and engagement; secondary outcomes were changes in anthropometric and clinical measures from baseline to post-program. Out of 38 recruited participants, 19 (50%) had T2DM (mean age 61.1 (SD 10.8) years, 10 (53%) female) and 18/19 (95%) completed the program. The 19 participants were active for a median of 7 days/week (IQR 4.76-7.0). Mean weight reduction was 3.9 kg (SD 4.1, p<0.001) and the average fat mass reduced by 2.4 kg (SD 2.9, p=0.002); a 4.9% relative change (SD 6.3). The median decrease in HbA1c levels was 4.0 mmol/mol (IQR -0.5, 5.0, p=0.05), fasting insulin decreased by 4.8 µU/ml (SD 9.2, p=0.03), and HOMA-IR by 2 mmol/L (SD 3.7, p=0.03). Mean systolic blood pressure reduced by 9.1 mmHg (SD 16.6, p=0.03), and relative liver fat by 18.6% (SD 25.3, p<0.01). These changes were not explained by changes in prescriptions or dosages, nor by self-reported medication adherence, and were not different between patients with or without T2DM. At the end of the 12-week digital intervention, participants with T2DM had improved glucose metabolism, liver fat values and body composition, suggesting that this digital intervention can help individuals with T2DM and NAFLD achieve better metabolic outcomes. Disclosure S. Bjornsdottir: Research Support; Sidekick Health, Reykjavik, Iceland. H. Úlfsdóttir: Employee; Sidekick Health. B. Dobies: Employee; Sidekick Health. E.F. Gudmundsson: Employee; Sidekick Health. K. Sveinsdottir: Employee; Sidekick Health. A.P. Isberg: Employee; Sidekick Health. G. Bjornsdottir: None. S. Sigurdsson: None. V. Gudnason: None.