2900-LB: CGM and Photo-Based Food Diary App in Type 2 Diabetes: A Pilot RCT

Introduction and Objective: Mhealth apps offer promise for improving DM management, yet most are not evidence-based. Undermyfork (UMF), a photo-based food diary app linking meal photos to CGM excursions, was assessed for glycemic effectiveness. Methods: A 4-month (M) parallel, 2-arm open label, comparative effectiveness RCT in adults with T2D compared CGM (Dexcom) (Arm 1) versus UMF+CGM (Arm 2) intervention with added emphasis on shaping health behavior change. Adults (age 18-80, A1c >7.7%, no prior CGM use, no bolus insulin use) completed a 10-day blinded CGM phase. Those with time-in-range (TIR) <70% and ≥7 days of wear were randomized to 20 days of unblinded intervention. Changes in CGM metrics (mean glucose and TIR) at day 20, and clinical/behavioral outcomes (HbA1c, PROs and diabetes medication dosage) at 4M were analyzed. Results: Of 91 participants enrolled [mean age 62.2 years (range 30-80); 59.3% male; White 76.1%, Asian 17.4% and Black 8.1%; avg. DM diagnosis 13.1 years; mean A1c 9.0%], 49 (54%) met criteria for randomization. Mean glucose significantly decreased from the blinded to unblinded phase across both arms (p=.023), reflecting benefit from CGM visibility. Participants randomized to Arm 2 had higher BMI (p=.040), poorer diet quality (p<.01), and higher baseline mean glucose (p=.039). Despite this disadvantage, reductions in mean glucose at day 20 and HbA1c at 4M were comparable between groups (∆ -11.0 vs -13.2 mg/dl, p=0.84) and (∆ -0.94 vs -0.78%, p=0.69) in Arm 1 and 2 respectively. Trends in TIR suggested a steeper upward trajectory across the 20 days in Arm 2. Conclusion: Participants with greater baseline metabolic risk achieved glycemic improvements comparable to CGM alone and demonstrated faster daily TIR gains when using UMF. An older, racially diverse group accepted mHealth approaches. UMF may strengthen the behavioral impact of CGM data by linking meals directly to excursions, supporting more informed dietary decisions. A larger trial will determine effectiveness and sustainability. Disclosure K. Brown: None. M. Ushakov: Stock/Shareholder; Current; Undermyfork, Inc. E. Molodkin: Stock/Shareholder; Current; Undermyfork Inc. S.R. Spierling Bagsic: None. C. Bell: None. A. Philis-Tsimikas: Research Support; Current; Dexcom, Inc., Lilly, Novo Nordisk. Advisory Panel; Current; Novo Nordisk, Gan & Lee Pharmaceuticals. Research Support; Current; Sanofi-Aventis U.S.