The eHealth Diabetes Remission Trial

One hundred and six overweight patients with type 2 diabetes replace usual foods with total diet replacement (850 kcal/day) for 3 months with the goal of 15 kg weight loss and diabetes remission (HbA1c \< 48 mmol/mol without diabetes medication). After 3 months of total diet replacement, food is reintroduced stepwise, and an individually tailored energy prescription is used to prevent weight regain. If study participants do not reach the weight loss goal at 3 months, they are recommended two additional months of total diet replacement. If weight regain occurs during the weight maintenance phase, a rescue plan with total diet replacement will be recommended. To increase the chances to maintain their lower body weight, participants will use a program specifically design for that purpose based on cognitive behavioural therapy. Total study duration is two years.

The one hundred and six participants are randomised to either the eHealth follow-up or the face-to-face follow-up. The dietary advice to achieve and maintain weight loss is the same in both groups and delivered by the same dietician, physician, and nurse but the method of follow-up differs between groups (eHealth vs face-to-face).

eHealth group:

All study information and the cognitive behavioural therapy program is given by an eHealth application in Stöd och behandling which is part of 1177.se. Participants register body weight, fasting blood glucose, and blood pressure every morning at 1177.se. Regularly a measurement of HbA1c is taken at home. Participants will have scheduled video appointments with the study dietician, study nurse or study physician.

Face-to-face group:

Participants have appointments in the medical office with the study physician/nurse/dietician. At the appointments, body weight, blood pressure and capillary blood glucose is measured. HbA1c is measured during the appointments at 0, 6, 12 and 24 months. The cognitive behavioral therapy program for the control group is identical to the program of the intervention group, but the program is delivered during the face-to-face appointments.

Healthy control group:

Fifteen healthy participants with normal glucose tolerance, stable body weight for at least one year and matched to the study participants for sex, age, and weight after one year study duration, will be examined once. These participants are not randomised and do not receive any intervention.

Outcomes:

Primary and secondary outcome measures are compared between 1) the experimental eHealth group and 2) the experimental face-to-face group. For the other pre-specified outcome measures the experimental eHealth group and the experimental face-to-face group are taken together as one group, examined twice (baseline and 12 months) and compared to the healthy control group, that is examined only once.

Long-term follow-up:

Because long term data on diabetes remission by total diet replacement are lacking, study participants will be followed after they have finished the study. Data of the national diabetes registry from participants of this study will be compared to other patients in the national diabetes registry not participating in this study but matched for age, sex and diabetes duration to the study participants.

• HbA1c [Срок оценки: 6 and 24 months]
• Diabetes remission [Срок оценки: 6, 12 and 24 months]
• Body weight [Срок оценки: 6, 12 and 24 months]
• Achieved weight loss of at least 15 kg [Срок оценки: 6, 12 and 24 months]
• Incremental costs per diabetes remission [Срок оценки: 24 months]
• Estimated lifetime costs [Срок оценки: 24 months]
• Estimated lifetime costs per quality-adjusted life-year (QALY) [Срок оценки: 24 months]
• Fasting blood glucose [Срок оценки: 6, 12, 24 months]
• P-glucose 120 minutes after the oral glucose tolerance test [Срок оценки: 6, 12, 24 months]
• Number of prescribed oral anti diabetic medications [Срок оценки: 6, 12, 24 months]
• Number of prescribed antihypertensive medications [Срок оценки: 6, 12, 24 months]
• Blood pressure (systolic/diastolic) [Срок оценки: 6, 12, 24 months]