Baseline HbA1c is associated with glycemic response to digital personalized nutrition in type 2 diabetes: A real-world study

Abstract

Background and aims Digital personalized nutrition is increasingly implemented in type 2 diabetes care, but the therapeutic effects appear to be heterogeneous in real-world settings. The aims of this study were to evaluate variations in the glycemic response to a digital personalized dietary intervention and identify baseline determinants of treatment effectiveness. Methods In this prospective real-world before–after study, 47 adult outpatients with type 2 diabetes received individualized dietary recommendations generated by a web-based platform, with unchanged pharmacotherapy. Glycated hemoglobin (HbA1c), dietary intake, and body mass index were assessed at baseline and after 2–3 months. Subgroup analyses were performed according to baseline HbA1c (<7.0% vs ≥ 7.0%). Results The intervention was associated with significant reductions in energy intake and body mass index. The overall change in HbA1c at the population level was modest, but a pronounced and statistically significant reduction was observed in patients with baseline HbA1c ≥ 7.0% (p = 0.003), whereas no meaningful change occurred in patients with well-controlled baseline glycemia. Baseline HbA1c was associated with the magnitude of the glycemic response to the intervention. Conclusions Digital personalized nutrition in routine clinical practice resulted in heterogeneous glycemic effects rather than a uniform population-level response. Clinically meaningful improvement was primarily observed in patients with elevated baseline HbA1c, supporting a targeted implementation strategy and highlighting the importance of patient stratification in digital dietary interventions.