Reducing HbA1c in Type 2 Diabetes Using Digital Twin Technology-Enabled Precision Nutrition: A Retrospective Analysis
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ORIGINAL RESEARCH
Reducing HbA1c in Type 2 Diabetes Using Digital Twin Technology-Enabled Precision Nutrition: A Retrospective Analysis Paramesh Shamanna . Banshi Saboo . Suresh Damodharan . Jahangir Mohammed . Maluk Mohamed . Terrence Poon . Nathan Kleinman
. Mohamed Thajudeen
Received: July 14, 2020 / Accepted: September 12, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: The objective of this study was to examine changes in hemoglobin A1c (HbA1c), anti-diabetic medication use, insulin resistance, and other ambulatory glucose profile metrics between baseline and after 90 days of participation in the Twin Precision Nutrition (TPN) Program enabled by Digital Twin Technology. Methods: This was a retrospective study of patients with type 2 diabetes who participated in the TPN Program and had at least 3 months Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare. 12943226. P. Shamanna Twin Health, Bangalore, Karnataka, India B. Saboo Dia Care Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India S. Damodharan Department of Diabetes and Endocrinology, Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu, India J. Mohammed M. Mohamed T. Poon M. Thajudeen Twin Health, Mountain View, CA, USA N. Kleinman (&) Kleinman Analytic Solutions, LLC., Missouri City, Texas, USA e-mail: [email protected]
of follow-up. The TPN machine learning algorithm used daily continuous glucose monitor (CGM) and food intake data to provide guidelines that would enable individual patients to avoid foods that cause blood glucose spikes and to replace them with foods that do not produce spikes. Physicians with access to daily CGM data titrated medications and monitored patient conditions. Results: Of the 89 patients who initially enrolled in the TPN Program, 64 patients remained in the program and adhered to it for at least 90 days; all analyses were performed on these 64 patients. At the 90-day follow-up assessment, mean (± standard deviation) HbA1c had decreased from 8.8 ± 2.2% at baseline by 1.9 to 6.9 ± 1.1%, mean weight had decreased from 79.0 ± 16.2 kg at baseline to 74.2 ± 14.7 kg, and mean fasting blood glucose had fallen from 151.2 ± 45.0 mg/dl at baseline to 129.1 ± 36.7 mg/dl. Homeostatic model assessment of insulin resistance (HOMA-IR) had decreased by 56.9% from 7.4 ± 3.5 to 3.2 ± 2.8. At the 90-day follow-up assessment, all 12 patients who were on insulin had stopped taking this medication; 38 of the 56 patients taking metformin had stopped metformin; 26 of the 28 patients on dipeptidyl peptidase-4 (DPP-4) inhibitors discontinued DPP-4 inhibitors; all 13 patients on alpha-glucosidase inhibitors discontinued these inhibitors; all 34 patients on sulfonylureas were able to stop taking these medications; two patients stopped taking
Diabetes Ther
pioglitazone; all ten patients on sodium-glucose cotransporter-2 (SGLT2) inhibitors stopped taking SGLT2 inhibitors; and one patient stopped taking glucagon-like peptide-1 analogues. Conclusion: The results provide
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