NTU-JO Smart Program: 1. CGM phase (weeks 1-2) During the initial 14 days of the intervention period, participants will be equipped with a CGM device. The primary goal of this short-term monitoring is to provide real-time physiological biofeedback. By visualizing the immediate fluctuations in glucose levels, participants will directly observe the impact of specific dietary choices and physical activities on their metabolic state. This "teachable moment" is designed to enhance metabolic literacy and catalyze intrinsic motivation for sustained behavioral modification.
2. AI-assisted community-based exercise program (months 1-6) Following the initial assessment at the NTUH Exercise Counseling \& Prescription Clinic, participants will engage in a 6-month, structured, multicomponent exercise program. This program integrates facility-based training using smart equipment with remote health coaching, designed to overcome common barriers to adherence in patients with KOA and obesity
Study summary
This study recruits patients with coexisting obesity and knee osteoarthritis (KOA) to implement the NTU-JO Smart Program, an innovative intervention integrating AI-assisted community-based exercise with continuous glucose monitoring (CGM). The primary objective is to investigate whether this intervention can improve glycemic control in this comorbid population. Other outcome measures include the risk of total knee arthroplasty (TKA), body weight changes, pain intensity scores, bone mineral density (BMD), cognitive function, as well as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores, which reflect the patients' overall functional status. The project also sought to explore the long-term association of the NTU-JO Smart Program with the development of type 2 diabetes (T2D) and major renal events, thereby facilitating patient-centered early treatment.
Eligibility
Sex
ALL
Min age
18 Years
Max age
75 Years
Healthy volunteers
No
Inclusion Criteria:
* Age: 18 to 75 years.
* Obesity status: body mass index (BMI) ≥ 27 kg/m², consistent with the obesity definition defined by the Health Promotion Administration, Ministry of Health and Welfare, Taiwan.
* Diagnosis of KOA in at least one knee according to the American College of Rheumatology (ACR) criteria, with a Kellgren-Lawrence (KL) grade of 1, 2, or 3.
* Symptomatic disease: defined as a WOMAC pain subscale score (range 0-20) greater than 4 at screening.
* Sedentary lifestyle: defined as less than 30 minutes of physical activity per week for the past 6 months.
* Informed consent: willing and able to provide written informed consent and comply with all longitudinal study procedures.
* Comorbid status: participants may be included regardless of a baseline diagnosis of T2D or CKD. Stratified randomization and subgroup analyses will be conducted based on these baseline conditions.
Exclusion Criteria:
* KL grade 4 KOA in either knee.
* Diagnosis of inflammatory arthritis, such as rheumatoid arthritis or psoriatic arthritis.
* Knee arthroscopy within the past 3 months or previous surgical history of TKA.
* Recent receipt of intra-articular injections (e.g., corticosteroids, hyaluronic acid) within the past 3 months.
* Documented history of osteoporotic fracture in hospital or cloud-based medical records.
* Type 1 diabetes.
* Presence of conditions precluding safe participation in an exercise program, such as unstable cardiovascular disease or severe neurological disorders.
* Participation in another interventional clinical trial within the past 3 months.
* Engagement in dietary regimens likely to cause significant weight change (e.g., intermittent fasting, such as the 16:8 time-restricted eating) within 1 month prior to trial initiation.
* Use of any FDA-approved weight-loss medications (e.g., semaglutide, tirzepatide) within 3 months prior to trial initiation.
* History of any form of surgical treatment for weight loss.
* Current use of lithium or antipsychotics at a dose equivalent to olanzapine \>20 mg/day.
* Pregnant or breastfeeding women, or women of childbearing potential without adequate contraception.
* Current malignancy (within the validity period of a catastrophic illness certificate), or any other clinical condition deemed unsuitable for participation by the investigator (investigator discretion).
* Inability to use smart devices or telecommunication tools due to severe visual/hearing impairment or lack of internet access.
Primary outcome measure(s)
Number of participants with worsening glycemic control over 6 months — From enrollment to the end of intervention at 6 months Risk of worsening glycemic control, defined as an increase in glycated hemoglobin (HbA1c) of ≥ 0.5% from baseline assessed over the 6-month intervention period (regardless of baseline diabetes diagnosis)
Trial sites (2)
Facility
City
Region
Status
National Taiwan University Hospital
Taipei
Taiwan
Recruiting
National Taiwan University Hospital Yunlin Branch
Yunlin
Taiwan
Recruiting
More National Taiwan University Hospital trials in Taiwan
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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