METHODS

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Subjects

As part of this study, 41 participants were enrolled between April 2021 and March 2022. The inclusion criteria were presence of Diabetes (HbA1c > = 6.5%), or Prediabetes (5.7% <= HbA1c <= 6.4%) or being on Diabetes medications or being obese/overweight (BMI > = 23). The participants of this study were mainly recruited through referrals and word of mouth. The exclusion criteria included advanced cardiac, renal, or hepatic dysfunction, pregnancy, or planned pregnancy.

 

The Good Health Clinic (TGHC)

The Good Health Clinic delivers a completely digital, personalized health coaching program including health analysis, personalized meal and exercise plans, biomarker feedback, behavioural counselling, and coordination with participant’s physicians. In this study, as part of the health analysis, the participants responded to a comprehensive questionnaire and underwent a complete metabolic health check-up consisting of more than 120 biomarkers including HOMA-IR, Blood glucose, HbA1c, lipids, inflammation markers such as CRP and homocysteine, liver, and kidney function tests. An initial correspondence was scheduled between the participant and their health coach to discuss the results of the health analysis. TGHC’s evidence-based analysis helped the participants understand their health baseline and identify any undiagnosed health conditions.

After the first consultation, an individualised plan for meals, supplements, exercise, stress, and sleep improvement was prepared by the health coaches. The plan took a multifactorial approach to resolve participant’s health issues. Unlimited one-to-one health coaching and support for health plan implementation, at-home biomarker monitoring, prescription adherence, and physician coordination was provided by TGHC coaches. 

The participants of this study communicated either on email or WhatsApp with their assigned health coaches who could view their health progress digitally. The participants also received educational content for self-awareness, mutually set goals and cheering community members for a sustainable change. They could also opt for consulting with TGHC’s counselling psychologists for getting counselling on any behaviour change such as smoking cessation, anxiety, unhealthy eating, or other issues. The health coaches did fortnightly check-in calls and monitored home glucometer, blood pressure, weight, and waist size readings. They also tracked meals and activities such as exercise, sleep, and mood. Every 3 months, the participants repeated their lab tests to quantify improvements that could be shared with their doctors to make informed therapeutic decisions [Figure 1]. 

 

TGHC’s Personalized Health Program

The TGHC program combines personalized plant-based whole foods with time restricted eating within 8-10 hours and fractionized exercise three times a day. The plant-based whole foods are designed with the participant based on their dietary preferences and are eaten to satiety with no portion or calorie control. The participants are encouraged to eat plant-based whole foods most of the time but are not asked to completely stop eating animal-based foods. They are educated on the benefits of plant-based whole foods such as high fibre which promotes satiety, prevents glucose and insulin spikes, protects our liver, feeds our gut bacteria keeping our digestion healthy, and being rich in micronutrients such as vitamins, minerals, and antioxidants which lower inflammation, boost immunity and improve insulin sensitivity. They are also made aware of the ill effects of animal foods such as having no fibre, high in saturated and trans fats, cholesterols, branched chain amino acids and chemicals that the animals are subjected to such as antibiotics and growth hormones all of which are harmful for our metabolism. 

 

Participants are also told to practise Time Restricted Eating (TRE) by eating within 10–12-hour windows which has been shown to automatically bring down caloric intake, keep insulin levels low during the remaining hours of the day thereby promoting insulin sensitivity and lipolysis and lowering inflammation levels caused due to eating throughout the day. TRE also promotes good sleep and better energy levels the next day because eating too close to bedtime is shown to adversely affect sleep quality because insulin and melatonin (the sleep hormone) act antagonistically [13]. Finally, participants are encouraged to perform fractionized physical activity of 10-15 minutes after each meal thrice a day. Fractionized exercise is also more easily incorporated into daily plans because it’s easier to find 10 min thrice a day for busy professionals than finding 30 min once a day. 

 

In this study, the aim of this synergistic approach was to attack the root cause of Diabetes and Obesity which is insulin resistance and thus improve glucose levels and lower lipids, weight, waist circumference and use of medicines. During the study, the participants were coached not to limit their calorie or any specific macronutrient intake. The study participants received a detailed health analysis, individualised plans, unlimited coaching, and motivation to transform their health. They also attended the weekly live or recorded sessions on fitness, ergonomics, physiotherapy, yoga, and meditation. The coaches also supported the participants in having a constructive and informative dialogue with their physicians and encouraged them to stay compliant with their prescriptions, clinic visits and diagnostic tests. In this study, medication reduction refers to decrease in daily insulin dosage or decrease in the number of non-insulin Diabetes medication categories in participants who were on insulin therapy or on non-insulin Diabetes medications or both at the start of the TGHC program. Dosage reduction of non-insulin medications was noted with several participants but was not counted as a part of medication reduction in this study.

 

Outcome Measures and Statistical Analysis

The metabolic health of the participants was determined at baseline and again at 3 to 6 months’ follow-up in the program. Any participant on hypoglycaemic medication or with HbA1c level of 6.5% or greater was considered Diabetic and HbA1c higher than 5.6% and lower than 6.5% was considered prediabetic. Participants with a BMI greater than 23 at baseline were considered overweight or obese. The primary outcome of this study was defined as improvement in health and anthropometric outcomes such as HbA1c levels, fasting and postprandial glucose levels, weight and waist circumference and as reduction in Diabetes medications. Secondary outcome was improvement in lipid profile such as reduction in total cholesterol and triglycerides. Standard laboratory procedures were followed for obtaining lab test results.

 

Each variable’s mean and standard deviation was calculated using descriptive statistics. Paired-sample t tests were used to compare and evaluate the differences of primary and secondary outcome variables at baseline and at 3 to 6 months’ follow-up. Statistical significance was set a priori at P < .05 [18].

 

ACKNOWLEDGEMENTS

The authors thank the study participants for their commitment to adhere to the program’s prescription. We appreciate the health coaches who worked diligently with the study participants to help them achieve their goals - Khushboo Pathak, Pooja Murjani and Amritha Shankar. 

 

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