3:00 - 3:20 pmSaturday, September 6
LK 102
Randomized trial indicates effectiveness of an online diabetes prevention program
LK 102
Randomized trial indicates effectiveness of an online diabetes prevention program
Professor Emerita, UC Berkeley
BackgroundSeventy-nine million Americans, one-third of all adults, have pre-diabetes, many of whom will progress to diabetes. Our health care system needs strategies that can reach those 79 million pre-diabetics... Read more

Description

Background

Seventy-nine million Americans, one-third of all adults, have pre-diabetes, many of whom will progress to diabetes. Our health care system needs strategies that can reach those 79 million pre-diabetics with assistance in changing their health behaviors. Alive-PreventDiabetes (Alive-PD) is a scalable, completely automated one-year multimedia email-web-smartphone program to help pre-diabetics improve their physical activity, eating habits and weight.

Methods

Alive-PD is designed to build habits of increased physical activity and reduced carbohydrates and fats. The approaches and techniques are based on health behavior-change principles, and include long- and short-term goal-setting, a user-defined activity plan, diabetes-focused health information, social support, tailoring and motivational messaging.

However, to be effective, technology-based behavior-change programs must overcome the common problem of low engagement and dropout. In creating Alive-PD, NutritionQuest focused on features to increase and sustain engagement. Different learning styles are engaged through infographics, quizzes, and automated phone-based coaching (IVR). A team system promotes competition between and support within teams, and sharing with social media is enabled. Engaging in online activities on the web page earns points, which may be used for monetary rewards or contributions to charity.

A randomized controlled trial is being conducted by NutritionQuest in collaboration with the Palo Alto Medical Foundation Research Institute, in Palo Alto, California. To maximize recruitment, subjects were eligible if they were pre-diabetic by either fasting glucose or HbA1c. Participants were randomized to begin the Alive-PD program immediately or after a six-month delay. The primary endpoints are change in hemoglobin A1c and glucose. Secondary endpoints are change in weight, lipids and blood pressure. Clinic visits occur at baseline, three, six and 12 months. 

Results

Among the 340 participants, mean age is 55 years, mean BMI 31, 69% are male and 67% are white. Participants were eligible if they were pre-diabetic by either fasting glucose or HbA1c, but most were at the low end of eligibility, and only 45% were pre-diabetic by HbA1c, while 55% were normoglycemic by HbA1c. Mean fasting glucose was 109.9 mg/dL and mean HbA1c was 5.6%.

We report here treatment results for the 272 participants who have reached the 3-month time point. The changes in the Intervention group were statistically significantly greater than those in the Control group for all three major outcomes. Change in Intervention and Control: Fasting glucose -3.5 vs. -0.2 mg/dL, p=.009. HbA1c -.15 vs. -.09%, p=.006. Weight -5.1 vs. -1.3 lbs, p<.0001.

Engagement was measured as having done one or more of the following: Chosen, achieved or reported on a goal; answered a quiz; logged with the tracking tool; or sent a support message. Engagement and retention were good, with 78% having done one or more of these activities during the last four weeks of the three-month period.

Conclusion

These preliminary data suggest that Alive-PD is effective and scalable.

 

Dr. Gladys Block is an emerita professor at the University of California at Berkeley and former director of the Public Health Nutrition program at the School of Public Health. She is founder and scientific director at NutritionQuest, a small business that provides diet and exercise research tools, and provides the Alive! program, an email/web tool to help people improve their physical activity and food habits.

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