Outcomes of a smart-phone delivered diabetes prevention program for patients with prediabetes: 1-year real-world service evaluation (Preprint)

2020 ◽  
Author(s):  
Charlotte Summers

BACKGROUND Prediabetes is the state of elevated blood glucose levels with glycaemic parameters above normal but below the (type 2) diabetes threshold. Prediabetes is considered a state of high risk for developing type 2 diabetes with yearly transition rate of 5%-10% to type 2 diabetes. There are almost 86 million adults with prediabetes in the United States alone. The world-wide prevalence of impaired glucose tolerance (IGT; a parameter of prediabetes) in 2010 was estimated to be 343 million (7.8%). Prediabetes is a global burden, with the International Diabetes Federation projecting an increase in prevalence of prediabetes to 471 million globally by 2035. OBJECTIVE Our objective was to evaluate the 1-year outcomes of the smart-phone delivered Low Carb Program for Prediabetes, a nutritionally focused, 12-session educational intervention for glycaemic control and weight loss for adults with prediabetes (i.e. a type 2 diabetes prevention program). The program reinforces carbohydrate restriction using behavioural techniques including goal setting, peer support, and behavioural self-monitoring. METHODS The study used a quasi-experimental research design comprised of an open-label, single-arm, pre-post intervention using a sample of convenience. We followed all of the 260 adults with prediabetes who had activated their referral to the program as a result of an NHS consultation between December 2018 and March 2019 and followed them for 12 months (N=260; mean age 44.7, SD 9.48 years; 36.1% (94/260) women; mean glycated haemoglobin A1c (HbA1c) 6.25%, SD 0.11%; mean body weight 77.1kg, SD 17.5kg; taking mean 0.41, SD 0.49 diabetes medications). RESULTS Of the 260 participants followed, 221 (85%) individuals reported outcomes at 12 months. 122 (46.9%) completed 80% or more of lessons of the program. Of the 260 participants with a starting HbA1c at or above the prediabetes threshold of 6.0%, 124 (49.6%) reduced their HbA1c to below the threshold. Over a third (33.8%, 88/260) of all participants lost at least 5% of their body weight. Overall, glycaemic control and weight loss improved, especially for participants who completed all modules of the program. For example, participants who engaged in at least 10 of the 12 weekly modules reduced their HbA1c from 6.3% to 5.8% (P<.001) and lost an average of 4.38kg or 5.4% of their body weight (P<.001). CONCLUSIONS A smart-phone delivered program that teaches a carbohydrate-reduced diet to adults with prediabetes with behaviour change support can be scalable and effective for glycaemic control, weight loss and can act as an engaging intervention for diabetes prevention.

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Nabil Sulaiman ◽  
Elaine Hadj ◽  
Amal Hussein ◽  
Doris Young

In Australia, type 2 diabetes and prediabetes are more prevalent in culturally and linguistically diverse (CALD) communities than mainstream Australians. Purpose. To develop, implement, and evaluate culturally sensitive peer-supported diabetes education program for the prevention of type 2 diabetes in high-risk middle-aged Turkish- and Arabic-speaking people. Methods. A two-day training program was developed. Ten bilingual peer leaders were recruited from existing health and social networks in Melbourne and were trained by diabetes educators. Each leader recruited 10 high-risk people for developing diabetes. Questionnaires were administered, and height, weight, and waist circumference were measured at baseline and three months after the intervention. The intervention comprised two 2-hour group sessions and 30 minutes reinforcement and support telephone calls. Results. 94 individuals (73% women) completed the program. Three months after the program, the participants’ mean body weight (before = 78.1 kg, after = 77.3; Z score = −3.415, P=0.001) and waist circumference (Z = −2.569, P=0.004) were reduced, their diabetes knowledge was enhanced, and lifestyle behaviours were significantly improved. Conclusions. A short diabetes prevention program delivered by bilingual peers was associated with improved diabetes awareness, changed lifestyle behaviour, and reduction in body weight 3 months after intervention. The findings are encouraging and should stimulate a larger control-designed study.


Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 675-P
Author(s):  
DOROTA CARPENEDO ◽  
SARAH M. BROKAW ◽  
SONJA TYSK ◽  
JESSIE FERNANDES ◽  
STEVEN D. HELGERSON ◽  
...  

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Yoshimi Fukuoka ◽  
Eric Vittinghoff ◽  
Julie Hooper

Background: Latinos have the highest prevalence of overweight or obesity (77.1%) when compared with other racial/ethnic groups in the United States. More than half of Latino adults living in the United States are expected to develop type 2-diabetes in their lifetime. Despite the growing interest in smartphone use for weight-loss and diabetes prevention, relatively few clinical trials have evaluated the efficacy of mobile app -based interventions in Latino populations. Purpose: To evaluate the potential efficacy of an in-person weight loss intervention in conjunction with a commercially available Fitbit app in a Latino sample at risk for type 2 diabetes and explore significant predictors associated with weight loss. Methods: After the run-in period, 54 self-identified Latinos with Body Mass Index (BMI) > 24.9 kg/m 2 were enrolled in an 8-week uncontrolled pilot study, and received a Fitbit Zip, its app and two in-person weight loss sessions adapted from the Diabetes Prevention Program. Results: Mean age was 45.3 (SD ± 10.8) years, 61.1% were born in the U.S, and mean BMI was 31.4 (SD ± 4.1) kg/m 2 . Overall, participants lost an average of 3.3 (SD ± 3.4) % of their body weight (p <.0005), corresponding to an average change of -2.4 kg (-5.3 lb) (p<.0005), respectively. We also observed statistically significant reductions in hip and waist circumferences, and systolic and diastolic blood pressure (p < 0.001). After controlling for demographic factors, use of the mobile app weight diary at least twice a week (p = 0.01) and change in the International Physical Activity Questionnaire score (P=0.033) were associated with change in percent body weight. Conclusions: The intervention showed the potential efficacy of this intervention, which should be formally evaluated in a randomized controlled trial.


2020 ◽  
Author(s):  
Ryan Batten ◽  
Meshari F Alwashmi ◽  
Gerald Mugford ◽  
Misa Muccio ◽  
Angele Besner ◽  
...  

BACKGROUND The prevalence of diabetes increasingly rapidly. Previous research has demonstrated the efficacy of a diabetes prevention program (DPP) in lifestyle modifications which can prevent or delay the onset of type 2 diabetes among individuals at-risk. Digital DPPs have the potential to utilize technology, in conjunction with behavior change science, to prevent prediabetes on a national and global scale OBJECTIVE The aim of this study was to investigate the effects of a digital DPP (VP Transform for Prediabetes) on weight loss and physical activity among participants who had completed twelve months of the program. METHODS This study was a secondary analysis of retrospective data of adults with prediabetes who were enrolled in VP Transform for Prediabetes for 12 months of the program. The program incorporates interactive mobile computing, remote monitoring, an evidence-based curriculum, behavior tracking tools, health coaching and online peer support to prevent or delay the onset of type 2 diabetes. Analysis included data that were collected at baseline and after 12 months of the VP Transform for Prediabetes DPP. RESULTS The sample (N=1,095) comprised people with prediabetes who completed 12 months of the VP Transform for Prediabetes program. Participants included 67.7% female, with a mean age of 53.6 (SD 9.75). On average, participants decreased their weight by 10.9 pounds (5.5%) and increased their physical activity by 91.2 minutes per week. CONCLUSIONS These results suggest that VP Transform for Prediabetes is effective at preventing type 2 diabetes through significant reduction in body weight and increase of physical activity. Furthermore, these results suggest that the DPP remains effective 12 months after beginning the program. A prospective, controlled clinical study is warranted to validate these findings.


2020 ◽  
Author(s):  
Bryan Gibson ◽  
Sara Simonsen ◽  
Jakob Jensen ◽  
Leah Yingling ◽  
Julia Schaeffer ◽  
...  

BACKGROUND The Diabetes Prevention Program (DPP) reduces the risk of developing Type 2 Diabetes, however enrollment is very low. OBJECTIVE The goal of this project was to pilot test the efficacy of two brief, immersive mobile phone videos (presented either in virtual reality or 360 video) on risk perceptions and enrollment in the DPP. METHODS Adults with prediabetes were recruited at a clinic serving a low income Hispanic community. After consenting, participants completed a baseline survey that collected demographics and risk perceptions based on the tripartite model of risk perceptions.. They were then informed that they had prediabetes and provided with a link to an educational website that explains: what prediabetes and Type 2 Diabetes (T2DM) are, how lifestyle affects risk of T2DM, what the DPP is, and where to enroll. Participants then viewed two videos using their smartphone ; either with a cardboard VR headset (VR) or their smartphone alone (360 video), per random assignment. Two weeks later a follow-up survey collected measures of: enrollment in the DPP, risk perceptions, health literacy, the importance of contextual factors related to the DPP in their decision of whether or not to enroll in the DPP (e.g. distance to the class ), and qualitative feedback on the interventions. We used logistic regression to determine whether enrollment in the DPP differed by intervention mode, while accounting for heath literacy and contextual factors related to the DPP. We used unpaired t-tests to examine differences in change in risk perceptions between groups. We used paired t-tests to examine within-subject changes in risk perceptions. RESULTS 116 participants provided complete data. Most participants were middle-aged (mean age= 44.6 yrs.; SD= 11.9) Hispanic (114/116), female (79/116), with low health literacy (mean score =12.3/20; SD=3.4). Enrollment in the DPP was 44/116 overall (37.9% ) but did not differ by group ( OR for enrolling in VR group= 1.78 ; 95% CI: 0.75-4.3, p=0.19) . Individuals who rated t the distance needed to travel to attend the DPP as more important were less likely to enroll in the DPP (OR = 0.56, 95% CI:0.33-0.92; p=0.03) Risk perceptions did not differ by group ( mean change in 360 video group = -0.07, mean change in VR group = 0.03, t==0.6, p= 0.54) and did not change within subjects ( mean 0.02, t=0.21, p=0.83). Participants feedback suggested that the videos are emotionally engaging and educational. CONCLUSIONS We present a pilot test of immersive mobile phone videos which appear to be efficacious in promoting enrollment in the DPP. Further work to determine the replicability of these findings, the mechanism of action of the videos, and potential moderators of the efficacy of these videos is discussed.


2019 ◽  
Vol 7 (1) ◽  
pp. e000619
Author(s):  
Nikki J Garner ◽  
Melanie Pascale ◽  
Kalman France ◽  
Clare Ferns ◽  
Allan Clark ◽  
...  

ObjectiveIntensive lifestyle interventions reduce the risk of type 2 diabetes in populations at highest risk, but staffing levels are usually unable to meet the challenge of delivering effective prevention strategies to a very large at-risk population. Training volunteers with existing type 2 diabetes to support healthcare professionals deliver lifestyle interventions is an attractive option.MethodsWe identified 141 973 people at highest risk of diabetes in the East of England, screened 12 778, and randomized 1764 into a suite of type 2 diabetes prevention and screen detected type 2 diabetes management trials. A key element of the program tested the value of volunteers with type 2 diabetes, trained to act as diabetes prevention mentors (DPM) when added to an intervention arm delivered by healthcare professionals trained to support participant lifestyle change.ResultsWe invited 9951 people with type 2 diabetes to become DPM and 427 responded (4.3%). Of these, 356 (83.3%) were interviewed by phone, and of these 131 (36.8%) were interviewed in person. We then appointed 104 of these 131 interviewed applicants (79%) to the role (mean age 62 years, 55% (n=57) male). All DPMs volunteered for a total of 2895 months, and made 6879 telephone calls to 461 randomized participants. Seventy-six (73%) DPMs volunteered for at least 6 months and 66 (73%) for at least 1 year.DiscussionIndividuals with type 2 diabetes can be recruited, trained and retained as DPM in large numbers to support a group-based diabetes prevention program delivered by healthcare professionals. This volunteer model is low cost, and accesses the large type 2 diabetes population that shares a lifestyle experience with the target population. This is an attractive model for supporting diabetes prevention efforts.


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