Can AI Replace Human Coaches for Diabetes Prevention?

Self-Portrait, painting in the style of futurism by Gino SeveriniA new study in JAMA suggests that AI can lead a fully automated diabetes prevention program and deliver outcomes that are just as good as programs with human coaches. Shall we view this as a threat? Or, more optimistically, as a tool to help with the challenge of delivering obesity care at scale?

A Mobile App

The trial enrolled 368 adults with overweight or obesity and prediabetes. The trial randomized them to a mobile-app based, AI-driven intervention (including a Bluetooth scale and push notifications via reinforcement learning) or a traditional CDC-recognized human-coach DPP delivered remotely.

At 12 months, 31.7% of the AI arm achieved the composite outcome and 31.9% of the human-coach arm did so. This fell within the prespecified range for saying that the outcome was not inferior with AI.

Scalability – with Caveats

What stands out is the potential scalability. The authors argue that an AI-led program may address serious real-world barriers: sparse DPP availability. There is only one program for every 63,000 U.S. adults with prediabetes. This contributes to low uptake and referral rates. Indeed, initiation and completion engagement were higher in the AI arm – 93% vs 83% initiated; 64% vs 50% completion.

But as the editorial by Leigh Perrault alongside this study notes, caveats abound. The composite end-point uses surrogate measures, not incident diabetes. The trial population was relatively motivated, digitally literate, and drawn from just two U.S. sites. The human coach program had to pivot to remote format (due to COVID), which may limit generalizability.

For the obesity-prevention, this trial signals a promising new option. If AI can reliably replicate coach-led outcomes, even modest effect sizes applied at population scale might move the needle on diabetes incidence. This might be a good tool for expanding the sadly limited reach of diabetes prevention programs

Click here for the study and here for the editorial. For further perspective, click here and here.

Self-Portrait, painting in the style of futurism by Gino Severini / WikiArt

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October 28, 2025