A digital health-supported Prediabetes Intervention, Management and Evaluation (PRIME) Program improves Healthy Eating Index score: A cluster randomized controlled trial

There has been increasing interest in digital health-supported interventions to facilitate lifestyle change for diabetes prevention. In this secondary analysis of a digital health-supported Prediabetes Intervention, Management and Evaluation (PRIME) cluster randomized controlled trial, we hypothesized that PRIME can improve dietary outcomes among overweight/obese people with prediabetes in Malaysia (n = 82). PRIME Program was only meant for the healthy population without any significant conditions other than prediabetes and metabolic syndrome. The intervention group received the PRIME mobile app equipped with nutrition education modules, online peer support for motivation, nutrition quizzes for reinforcement, and face-to-face personalized counseling sessions by health coaches, supported with real-time health data while control group received usual care. The outcomes included dietary quality, nutrient intake, and food group consumption. Adjusted mixed model analysis showed that the intervention group had a significant improvement in the total healthy eating index score (+7.69%, 95% CI: 3.53-11.85, P < .001), vegetables (+0.68 servings/d, 95% CI: 0.26-1.11, P = .002), refined grains (-0.61 servings/d, 95% CI: -1.01 to -0.21, P = .003) and sodium intake (-436.06 mg, 95% CI: -677.46 to -194.66, P < .001) when compared to the control group. The present study provided data to inform practice directed at supporting the implementation of a digital health-supported lifestyle intervention in complementing and augmenting existing strategies for diabetes prevention among high-risk groups in Malaysia.