The lack of effective, scalable solutions for lifestyle treatment is a global clinical problem, causing severe morbidity and mortality. We developed a method for lifestyle treatment that promotes self-reflection and iterative behavioral change, provided as a digital tool, and evaluated its effect in 370 patients with type 2 diabetes (ClinicalTrials.gov identifier: NCT04691973). Users of the tool had reduced blood glucose, both compared with randomized and matched controls (involving 158 and 204 users, respectively), as well as improved systolic blood pressure, body weight and insulin resistance. The improvement was sustained during the entire follow-up (average 730 days). A pathophysiological subgroup of obese insulin-resistant individuals had a pronounced glycemic response, enabling identification of those who would benefit in particular from lifestyle treatment. Natural language processing showed that the metabolic improvement was coupled with the self-reflective element of the tool. The treatment is cost-saving because of improved risk factor control for cardiovascular complications. The findings open an avenue for self-managed lifestyle treatment with long-term metabolic efficacy that is cost-saving and can reach large numbers of people.

生活方式治疗缺乏有效的、可扩展的解决方案是一个全球性的临床问题，导致严重的发病率和死亡率。我们开发了一种生活方式治疗方法，可促进自我反思和反复行为改变，作为数字工具提供，并评估了其在 370 名 2 型糖尿病患者中的效果（ClinicalTrials.gov 标识符：NCT04691973）。与随机对照和匹配对照（分别涉及 158 名和 204 名用户）相比，该工具的用户血糖降低，收缩压、体重和胰岛素抵抗也有所改善。在整个随访期间（平均 730 天）持续改善。肥胖胰岛素抵抗个体的病理生理亚组有明显的血糖反应，能够识别那些将特别受益于生活方式治疗的人。自然语言处理表明，新陈代谢的改善与工具的自我反思元素相结合。由于改善了心血管并发症的风险因素控制，这种治疗可以节省成本。这些发现为自我管理的生活方式治疗开辟了一条途径，该治疗具有长期的代谢功效，既节省成本，又可以惠及大量人群。