Want to Achieve Type 2 Diabetes Remission? Try These Coaching Programs
By Arvind Sommi
Five percent of people with type 2 diabetes could achieve remission, research says. In recent years, virtual clinics, coaching, and mobile apps have made achieving remission easier and more accessible.
Unfortunately, as of now, there is no “cure” for type 2 diabetes. However, it is possible to achieve diabetes remission, which is defined by the American Diabetes Association as maintaining an A1C below 6.5% for three months without the use of any glucose-lowering medication. To learn more about diabetes remission, read our article: “Type 2 Diabetes Remission: What Is It and How Can it Be Done?”
What do the experts look for?
There are many different programs that claim to help their users achieve diabetes remission through virtual care teams, coaching and apps. But what makes an effective diabetes remission program and which ones are experts most likely to recommend?
Dr. Urmimala Sarkar, a primary care provider at the University of California, San Francisco, emphasized the importance of usability when evaluating mobile apps.
“While digital coaching services are important in providing an alternative to in-person visits, we need to ensure all people with diabetes have access and comfort with digital tools,” she said. Her team’s research has found that the best coaching apps use simple language and collect your health data automatically. Dr. Francine Kaufman, a pediatric endocrinologist and chief medical officer at Senseonics, recommends ensuring that a physician be directly involved in your care when considering digital health services.
Virta and Level2 – Leaders in the field
Virta and Level2 are currently two of the most prominent digital services – and both aim to specifically help people achieve diabetes remission or reversal. A distinction between the two is that Virta’s primary goal of diabetes reversal can be met if you only use metformin while Level2’s goal of diabetes remission requires you no longer use any diabetes-specific medications. In both of these programs, you will virtually meet clinicians as they review your health data and provide a personalized your diabetes treatment plan. We spoke with representatives from both companies, Paul Sytsma, senior director of corporate marketing at Virta, and Will Ferguson, chief growth officer at Level2, to learn more about each program and what they have to offer.
Virta in particular has peer-reviewed research showing that their program leads to improved glucose, weight, and other health factors from a clinical trial with 349 adults with type 2 diabetes. The data showed at one year, among completing patients:
Average A1C improved by 1.3 percentage points, from 7.5% to 6.2%
94% of those using insulin decreased or eliminated their dosage.
Participants were able to sustain, on average, a 12 % weight loss (this is twice the FDA benchmark for weight-loss drugs).
There were significant improvements in other conditions, including markers of heart disease, inflammation, and more.
At two years, completing participants experienced a 67.0% reduction in diabetes-specific prescriptions.
Virta provides you with a glucose monitor and test strips along with a connected scale that automatically uploads your weight to the app. You have to manually enter your glucose data into the Virta app so that you can review them with your coach and clinical team.
Level2’s results are from a small, non-peer reviewed, pilot study, but they suggest that Level2 could also lead to promising results:
Among Level2 members with a starting A1C greater than 8.0%, 91% improved their A1C within 90 days.
41% of Level2 members reported decreasing their waist circumference and 62% reported losing weight.
36% of members reported reducing their type 2 diabetes medications.
89% of members reported feeling better, and 78% reported feeling more confident in managing their type 2 diabetes.
Note that when it comes to the products provided to you as part of the service, Level2 places a greater emphasis on wearable health tracking devices – they provide a free Dexcom G6 continuous glucose monitor (CGM) and a Fitbit in conjunction with their program.
Your CGM data is used for personalized coaching and can provide more information on your glucose levels to your clinical care team of physicians, nurse practitioners, dieticians, and coaches. Virta does not provide a CGM, but it is “currently exploring the potential benefits that a CGM may provide our patients,” said Sytsma.
Personalized diabetes remission
Virta and Level2 aim to reduce diabetes medications over time, but one interesting consideration is that certain diabetes medications, such as SGLT-2 inhibitors and GLP-1 receptor agonists, have additional benefits outside of lowering a person’s glucose levels. Both Sytsma and Ferguson emphasized that each program weighs all of these factors to provide individual care that takes into account someone’s overall health.
“Our original goal was to de-prescribe all diabetes medications,” said Dr. Robert Ratner, the Chief Medical Officer of Virta. “We've revised that. We do not discontinue either GLP-1 [receptor agonists] or SGLT-2 [inhibitors] when the person has a glucose-independent indication for their use [for example, if the drug is approved for heart disease or kidney disease]. If they have heart failure, we don't take them off the SGLT-2. If they have a history of cardiovascular disease or stroke, we won't take them off their GLP-1. We're not just treating diabetes; we're treating each person.”
“Level2’s care teams work with each person and their primary care physician to determine together when it may make sense to reduce medications. Decisions regarding medication – tailoring, tapering, or ceasing – are always collaborative and made with the whole patient in mind,” said Ferguson.
If your healthcare insurance does not cover these services, you can also access direct-to-consumer (DTC) options. Virta’s DTC service is available for $249/month and a one-time $250 initiation fee. Level2’s DTC option is a free 30-day interactive experience that serves as a preview of their full service.
To learn more on both of these programs check out these resources:
- Leading Insurer Provides CGM to 230,000 Eligible Members with Type 2 Diabetes
- Can You Reverse Type 2 Diabetes? diaTribe Readers Review Virta
- Virta Health: Reversing Type 2 Diabetes with Low-Carb Diets & Coaching
Another new option to consider
In addition to Virta and Level2, a relatively new program, Twin Health, has recently moved into the US market and also aims to help people reverse or prevent metabolic conditions – including diabetes.
Twin Health uses thousands of data points from wearable sensors and self-reported preferences to create individualized guidance for each person.
In early trials, results showed that the program was effective at helping people put their type 2 diabetes into remission. On average, people reduced their A1C by 3.9 percentage points (from greater than 8.0% to below 5.7%) and their body weight by 20.3 lbs. In addition, results show that many people are able to eliminate the need for all diabetes medications, including insulin. They currently have ongoing trials to continue evaluating the effectiveness of this treatment.
You can learn more about Twin Health here and we will continue to update this article as we learn more about this new program.
(Disclosure: Virta’s CEO Sami Inkinen is a donor to diaTribe)