成人2型糖尿病晚餐后即时提醒减少零食的可行性研究
本研究在习惯晚餐后吃零食的成人2型糖尿病患者中，通过智能手机应用在晚餐后不久发送数字提醒，并用持续葡萄糖监测评估后续零食事件。研究对象为饮食控制或稳定口服降糖药至少3个月的患者，先经2周导入期确认行为，再进入2周每日微随机化阶段。结果显示全程提醒对CGM净增量曲线下面积无总体效应，但早期存在提醒效应并随时间减弱。
要点
- 晚餐后即时数字提醒对全程血糖净增量曲线下面积无总体改善。
- 提醒效应在初期显现，随后随时间逐渐减弱。
- 该即时提醒方式在成人2型糖尿病患者中初步具有可行性。
核心结论
- 全程分析中晚餐后即时数字提醒对CGM净增量曲线下面积无总体血糖获益。
- 探索性分析提示存在早期提醒效应，但效应随时间减弱，需进一步确认并探索维持策略。
- 研究初步证实在成人2型糖尿病患者中实施即时提醒具有可行性。
研究设计与样本
- 研究类型为微随机化试验，每日以1:1随机分配至即时图示提醒或无提醒。
- 纳入饮食控制或稳定口服降糖药至少3个月且每周至少3晚习惯晚餐后吃零食的成人2型糖尿病患者。
- 先进行2周导入期通过CGM确认晚餐后零食行为，随后进入2周微随机化阶段。
主要发现
- 导入期共收集911晚CGM数据，微随机化阶段收集780晚，共发送410次数字提醒。
- 主要结局为晚餐后90分钟至凌晨4点期间CGM增量曲线下面积在提醒日与非提醒日之间的差异，全程无效应。
- 次要分析显示提醒效应在初期存在，随后随时间减弱，零食行为和CGM目标范围内时间的结果相似。
临床怎么用
- 晚餐后即时数字提醒可作为一种行为干预方式应用于成人2型糖尿病患者，但不宜预期其能持续改善血糖。
- 若考虑使用该干预，需探索维持提醒效应的策略以延长其早期效果。
局限性
- 研究周期较短，仅2周微随机化阶段，无法评估长期效果。
- 提醒效应随时间减弱，提示存在习惯化或提醒疲劳的可能性。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
ABSTRACT Aims This study aimed to determine whether in people with Type 2 diabetes mellitus (T2DM), a digital nudge delivered by a smartphone app soon after dinner reduces subsequent snacking events as measured by continuous glucose monitoring (CGM). Methods Participants: Adults with T2DM, managed with diet or stable oral antidiabetic medication for at least 3 months, and who habitually snacked after dinner on ≥ 3 nights/week. Design: Pictographic nudges were co-designed with consumers. After-dinner snacking behaviours were confirmed during a 2-week Lead-In phase by CGM. Thereafter, eligible participants were micro-randomized daily (1:1, MRT phase) to either a pictographic nudge delivered-in-time (Intui Research) or no nudge for a second 2-week period. The primary outcome was the difference in incremental area under the CGM curve (net-iAUC) between nudging days and non-nudging days during the period 90-min post-dinner until 4 AM. Results Sixty-six participants completed the Lead-In phase and 56 completed the MRT phase with available CGM data. CGM data were collected over 911 nights during the Lead-In phase and 780 nights during the MRT phase, with a total of 410 digital nudges sent. Over the entire 2-week period there was no effect of nudging on the primary outcome (net-iAUC). However, secondary analyses showed that there was an initial nudge effect that faded over time. Similar results were observed for snacking behaviour and CGM time-in-range. Conclusion This study provides preliminary feasibility of delivering just-in-time nudges in adults with T2DM, with no overall glycaemic benefit. Exploratory early effects warrant confirmation and investigation of strategies to sustain efficacy. Trial Registration ACTRN12622000531718
引用
- Diabetes, Obesity and Metabolism：Efficacy and Feasibility of Just‐in‐Time Nudging in Reducing Evening Snacking Measured by Continuous Glucose Monitoring in Adults With Type 2 Diabetes: A Micro‐Randomized Study
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。