*Gladys Block, PhD
Berkeley Analytics, Inc. University of California at Berkeley
Oral Presentation – Business Track
Sunday, Sept 30, 2012: 12:48 PM – 1:08 PM – LK130
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*Presenting Speaker
Background
Fifty-seven million U.S. adults have pre-diabetes. Over half will eventually progress to Type 2 diabetes unless they increase their physical activity, improve their dietary habits and reduce their weight. The Diabetes Prevention Program demonstrated that these lifestyle changes will delay or prevent diabetes. However, that intervention involved extremely intensive in-person counseling, and consequently its reach is very limited. Internet-based approaches offer the possibility of low cost and wide impact.
Methods
NutritionQuest in Berkeley, CA., (www.nutritionquest.com) was awarded a grant from the National Institutes of Health to develop an intervention for pre-diabetics: Alive-PD. Alive-PD will be based on a modification of our existing email-Web-based program, Alive!, described further below.
Components of Alive-PD
Alive-PD focuses on increasing physical activity and improving food habits, leading to weight loss. Weekly emails bring the program to the user. Individualized goal-setting, personalization, building self-efficacy and motivational interaction form the core of the behavior-change approach. Suggested weekly goals are tailored to individuals’ current activity and diet, lifestyle, and personal characteristics. A user web page provides opportunities for tracking, interaction, challenges and gamification, and information. A mobile application will facilitate networking and social support. Optional print and phone components will reinforce the email/web application.
Evidence of effectiveness
We believe Alive-PD will be effective because the existing program, Alive!, was tested in a large randomized trial, and produced significant improvements in all endpoints: increased physical activity, reductions in saturated and trans fats, and increased fruits and vegetables. Importantly, these improvements were still significant four months after the conclusion of the intervention. Two journal articles have been published (http://www.nutritionquest.com/wellness/more-about-alive/). In addition, weight loss was seen in obese participants, even though Alive! did not have a weight loss emphasis. Alive! is seen on NCI’s RTIPS (http://rtips.cancer.gov/rtips/programDetails.do?programId=557543) and is spotlighted on ODPHP’s blog (http://www.health.gov/paguidelines/blog/post/Program-Spotlight-Alive.aspx). Alive! also had positive impacts on quality of life, and has been well-received (http://sanfrancisco.cbslocal.com/2011/07/12/healthwatch-email-program-helps-people-make-healthy-choices/#.Th0AOqjdUjs.email).
Randomized trial
Alive-PD will be tested in a randomized trial, in collaboration with the Palo Alto Medical Foundation. Participants with pre-diabetes will be recruited, and randomized to Alive-PD or a delayed control condition. Clinic visits at baseline, three months and six months will assess their weight and glucose status. Outcome measures will be change in body weight, glucose and hemoglobin A1c.
Conclusions
If proven effective, Alive-PD could become an important component of the standard of care for those with pre-diabetes, owing to the low cost of its delivery. It can provide long-term support and reinforce the physician’s in-person counseling. If only 5% of pre-diabetic Americans were reached and as few as 1/3 of them achieved the targeted behaviors, 1 million Americans would reduce their risk of type 2 diabetes and billions of dollars would be saved.
