Effectiveness and Cost-Effectiveness of Fully-Automated Digital vs. Human Coach-Based Diabetes Prevention Programs

The purpose of this research study is to compare the effectiveness of a fully automated digital diabetes prevention program to standard of care human coach-based diabetes prevention programs for promoting clinically meaningful lifestyle changes to reduce the risk of type 2 diabetes in adults with prediabetes.

Inclusion Criteria: * Provision of signed and dated informed consent form. * Stated willingness to comply with all study procedures and availability for the duration of the study. * Laboratory evidence of prediabetes, defined as any of the following lab results, in the past year: 1. Hemoglobin A1C 5.7% to 6.4% 2. Fasting glucose 100-125 mg/dL 3. Plasma glucose of 140-199 mg/dL measured 2 hours after a 75 gm glucose load * Body mass index (BMI) ≥25 kg/m2 (or≥23 kg/m2 for Asians). * Proficiency in reading English. * Smartphone user (Android Operating System (OS) 9.0 or iOS 13.3 or newer). * Plans to reside in recruitment area for the next 12 months (participant's zip code of residence is within \~45 miles of the study recruitment site. Exclusion Criteria: * Medical conditions that prevent adoption of moderate physical activity (per primary care clinician). * Aortic stenosis. * Unstable cardiac disease (myocardial infarction, heart failure, or stroke in previous 6 months, currently participating in cardiac rehabilitation). * Has a pacemaker, implantable cardioverter-defibrillator (ICD), or other implanted electronic device. * Use of any glucose-lowering medications, weight loss medications, or any systemic glucocorticoids within the previous 3 months. * Active malignancy of any type or diagnosed with or treated for cancer within the past 2 years. Individuals with basal and squamous cell carcinoma of the skin that has been successfully treated will be allowed to participate. * Diagnosis of diabetes mellitus. * Pregnancy or planned pregnancy in the next 12 months. * Anemia. * Receiving treatment for iron-deficiency anemia, vitamin B12 deficiency, or folate d efficiency. * Hemoglobinopathy (HbS or HbC disease). * Blood transfusion in previous 4 months. * On dialysis or active organ transplant list. * Treated with erythropoietin. * Major psychiatric disorder (schizophrenia) or use of antipsychotic medications within the past 1 year. * Dementia or Alzheimer's disease. * Diagnosed with an eating disorder (anorexia nervosa, avoidant/restrictive food intake disorder, binge eating disorder, bulimia nervosa, Pica, rumination disorder, other specified or unspecified feeding or eating disorder) * Diagnosed or self-reported alcohol or substance abuse. * Known allergy to steel. * Participation in another clinical trial related to lifestyle management or diabetes prevention. * Currently attending or attended a diabetes prevention program in the previous 2 years. * Unwilling to accept random assignments. * Had bariatric surgery within the 12 months prior randomization or is planning to undergo bariatric surgery during the study.