Digital, Blended Lifestyle Intervention for Type 2 Diabetes Remission

Inclusion Criteria:

• Diabetes: Diagnosis of T2DM without physician defined end-organ failure
• BMI: 25 to 45 kg/m²
• Age: 18 to 75 years
• Most recent HbA1c value should be greater than 6.0% (>43 mmol/mol); if less than 6.5% (<48 mmol/mol), individuals should still be receiving anti-diabetic medication
• Tech-savvy (patients are required to be able to fully use smartphone or tablet)
• Display interest and motivation to enroll in a digital, lifestyle intervention fordiabetes

Exclusion Criteria:

• Weight loss of more than five kg or greater than 10% within the past six months
• Serious co-morbidities, for example, a severe form of chronic obstructive pulmonarydisease (Gold III or IV), bariatric surgery, heart failure (classes 2-4) kidneyfailure, or another medically determined end-stage organ failure
• Substance abuse
• Learning difficulties limiting the participation in a digital health intervention andor limiting the comprehension of trial goals or coaching curriculum.
• Current treatment with anti-obesity drugs
• Pregnancy, consideration of pregnancy within the study period, lactation or havinggiven birth within the previous nine months
• Hospital admission for depression
• Major psychiatric disorder (e.g., schizophrenia, bipolar disorder) or use ofantipsychotic drugs.
• Currently uncontrolled or eating disorder or purging behavior
• Type 1 diabetes
• History of keto-acidosis
• Myocardial infarction, stroke, angina, or coronary insufficiency within the previoussix months
• Diabetic retinopathy requiring treatment
• Creatinine > 2.0 mg·dL-1 or > 152.5 µmol·L-1
• Urinary albumin > 1 g·dL-1 or > 10 g·L-1
• Cancer requiring treatment in the past five years, with the exception of non-melanomaskin cancer
• Chronic infectious disease requiring ongoing treatment
• Other chronic diseases or conditions likely to limit lifespan to less than six years
• Severe visual impairment or other impairment preventing interaction with digitalcontent
• Non-English or Non-Dutch speaking
• Excessive alcohol intake (acute or chronic) defined as the average consumption ofthree or more alcohol-containing beverages daily or consumption of more than 14alcoholic beverages per week
• Cholelithiasis or biliary dysfunction
• Use of an insulin pump
• Participation in diabetes therapy within the preceding three years; participation inconcurrent weight management or interventional research protocol,
• Untreated thyroid disease,
• Requirement of a prescribed medical diet
• A recent on-record estimated glomerular filtration rate of less than 30 mL/min per 1.732 m²
• Incapacitated patients, and thus unable to fully participate in the trial.
• uncontrolled blood pressure (SBP > 170 mmHg and/or DBP > 100 mmHg)
• For nutritional ketosis specifically: impaired hepatic function (Bilirubin >2 mg·dL-1or >34.2 µmol·L-1, Albumin < 3.5 g·dL-1 or <35 g·L-1)