Evaluation of a Digital Diabetes Prevention Program Adapted for Low-Income Patients, 2016–2018

Sue E. Kim, PhD, MPH; Cynthia M. Castro Sweet, PhD; Edward Cho, MD, MPH; Jennifer Tsai, PhD; Michael R. Cousineau, DrPH


Prev Chronic Dis. 2019;16(11):e155 

In This Article

Abstract and Introduction


Introduction: We examined the effects of a digitally delivered, type 2 diabetes mellitus prevention program (DPP) for a low-income population.

Methods: We conducted a nonrandomized clinical trial with matched controls. The intervention group was offered a digital DPP, a web-based and mobile-based program including 52 weeks of participation in an educational curriculum, health coaching, and peer support.

Results: A total of 227 participants enrolled. At baseline, 34.6 was the mean body mass index, and 5.8 was the mean HbA1c. For the intervention group, mean weight loss was 4.4% at the 12-month follow-up.

Conclusion: The modified DPP successfully engaged participants and resulted in weight loss. Low-income patients with prediabetes benefitted from a digitally delivered diabetes intervention. This prevention method should be accessible to a low-income population.


In 2015, 84 million US adults were estimated to have prediabetes and approximately 30 million were living with diabetes.[1] While diabetes prevention efforts increase, the incidence of type 2 diabetes mellitus and obesity remain disproportionately higher among low-income patients, including those from underrepresented racial and ethnic groups.[2,3]

The landmark Diabetes Prevention Program (DPP) demonstrated that lifestyle modifications improve healthy diet, increase physical activity, and sustain weight loss more effectively than prescription medication in preventing or delaying the onset of diabetes.[4,5] The success of the DPP lifestyle intervention highlights the role of behavioral interventions as effective, safe, and sustainable for diabetes prevention.[6–8] Translational efforts have disseminated the DPP through in-person groups, as well as online and digital formats through remote coach access, internet platforms, telecommunications, and smartphone apps, resulting in replication of DPP goals.[8,9]

Some DPPs have targeted low-income communities with modest but promising results.[10–14] Recurring limitations in many of these programs are dependency on face-to-face interactions, location-based meetings, and time-restricted options for group sessions. Limited flexibility of work schedules, access to reliable transportation, and access to affordable childcare are reported obstacles for participation in required, in-person DPP sessions.[15,16] Similarly, people in rural areas might live long distances from the nearest DPP location, posing a transportation challenge.

Given low-income communities' growing use and acceptance of accessible technologies,[17,18] a digitally delivered DPP might be an option for hard-to-reach populations with prediabetes.[19] We examined the effectiveness of a digital DPP adapted for a low-income population. We designed the study to measure participation in the program and its effectiveness in reducing risk for diabetes, compared with a nonparticipating matched group.