Diabetes, obesity & metabolism · 2026
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.
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Zhao Lijun, Bidargaddi Niranjan, Vakulin Andrew, Li Wenhao, Luscombe-Marsh Natalie, Benton Fiona, Adams Robert, Kemps Eva, Vincent Andrew D, Heilbronn Leonie K, Wittert Gary A
Аннотация
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.
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.