Online Diabetes Prevention Programs 'as Effective' as In-Person Ones

Liam Davenport

October 02, 2018

An online diabetes prevention program (DPP) supplemented with virtual support not only achieved similar weight loss to that seen with an in-person version but also increased engagement, say US investigators who believe virtual programs could have broader appeal than more traditional interventions.

Tannaz Moin, MD, MBA, MSHS, Veteran Affairs (VA) Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, California, and colleagues studied outcomes of an online DPP that combined individualized feedback, frequent self-monitoring with wireless scales, and social media-style features with weekly educational modules.

The almost 270 participants lost an average of 4.7 kg (10.3 pounds) at 6 months and 4.0 kg (8.8 pounds) at 12 months. This was similar to the weight loss seen when people attended an in-person DPP and far greater than that of a standard weight-loss program.

Earlier this year, the US Centers for Medicare and Medicaid Services announced that it will be expanding its DPP to all eligible at-risk beneficiaries with prediabetes aged 65 years or older, as well as those who have had gestational diabetes and are at high risk for type 2 diabetes.

This followed results of the intensive lifestyle-intervention from the DPP trial, which showed that patients with prediabetes who exercised daily and lost 5% to 7% of their body weight could cut their risk of type 2 diabetes by 58%.

Late last year, the Centers for Disease Control and Prevention  (CDC) also recognized the first fully mobile translation of the national DPP.

One of the First Work to Compare Online Program With Others

The current research, which is one of the first to compare outcomes between online and in-person DPPs, was published online September 24 in the American Journal of Preventive Medicine.

Although in-person DPPs have been shown to be effective in reducing the risk of developing diabetes, the researchers point out that their impact in the real-world can be reduced on a population level because of a lack of reach.

Online DPPs, however, have the potential to reach far more patients than in-person programs, especially as it is estimated that 87% of the US adult population uses the internet.

To determine how outcomes compare between online and in-person DPPs, Moin and colleagues conducted a nonrandomized trial in which overweight or obese veterans who had one or more obesity-related conditions and prediabetes were assigned to an online DPP.

The program comprised a 12-month intensive lifestyle intervention with weekly educational modules delivered asynchronously using a web-based platform.

Participants were invited to virtual groups based on factors such as age, body mass index (BMI), and geographic location. They were also given wireless weighing scales and encouraged to log their diet and maintain physical activity.

A human coach also monitored the online groups and provided individualized feedback by phone, private online messaging, or both, and participants could track their progress online.

In total, 268 individuals took part in the online DPP. Participants were a mean age of 60 years and had an average BMI of 32.6 kg/m2 and HbA1c of 6.0%. Most (69%) were men and white (71.3%).

Overall, 172 (64%) completed one or more online modules, 158 (59%) completed at least four sessions, and 149 (56%) completed at least eight sessions.

The online DPP resulted in significant average weight loss of 4.7 kg at 6 months and 4.0 kg at 12 months (P < .001). The mean percentage weight loss was also significant, at 4.4% and 3.7%, respectively (P < .001).

Comparison With In-Person Schemes and Standard Weight Loss Programs

The results were then compared with data from the parallel, nonrandomized VA-DPP trial of an in-person DPP (n = 273) and the VA's standard of care weight-loss program, MOVE! (n = 114), which had similar inclusion criteria as the online DPP.

In-person DPP consisted of 22 face-to-face sessions with a target 7% weight loss and at least 150 minutes/week of moderate physical activity, while MOVE! involved eight to 12 face-to-face healthy lifestyle sessions followed by monthly maintenance sessions.

The team notes that one or more sessions were completed by 198 patients in the in-person DPP and 64 patients in the MOVE! program, and these were included in the comparative analysis.

Although there was no significant difference in weight loss at 6 and 12 months between the online and in-person DPPs, those who took part in the online DPP had significantly greater weight loss than those in the MOVE! program at both timepoints (P < .001 for both percentage and absolute weight change).

Indeed, participants in the MOVE! program had little weight loss at 6 months, at 1.1 kg or an average reduction of 0.8%, an effect that had disappeared by 12 months.

The researchers point out that there are several limitations to their study, including the nature of the study cohort, lack of randomization, and need to adjust for weight assessment methods, which were different in the online and in-person programs.

Nevertheless, they write that "compared with in-person DPP, online DPP participants who completed one or more sessions/modules had significantly higher participation but comparable weight change."

The results not only demonstrate the effectiveness of the online DPP but suggest that its distinct interactive features, which are appealing and user friendly, can be used "to engage a higher proportion of individuals across a population," they suggest.

Future studies examining how online DPP intervention components can work together to impact participation and engagement are key, the add, concluding that overall, the findings, "may have important implications for national efforts to disseminate DPP."

The research was funded by the VA. Moin has reported receiving support from VA QUERI, CDC/National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases, and VA Office of Academic Affiliations. Mona AuYoung has reported receiving support through the VA Health Services Research and Development Advanced Postdoctoral Fellowship Program. Matthew L. Maciejewski has reported receiving support from the VA and ownership of Amgen stock. Charles J. Billington has reported receiving personal fees from Novo Nordisk and EnteroMedics outside of the submitted work.

Am J Prev Med. Published online September 24, 2018. Abstract

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