Online Programs May Assist Diabetes Prevention for US Veterans

Tannaz Moin, MD, MBA, MSHS

Trends show that more strides are being taken by more Americans to live a healthier lifestyle. Despite this, national obesity, cardiovascular disease, and diabetes rates are reaching epidemic levels—approximately 84.1 million Americans currently have prediabetes, and another 100 million-plus have diabetes.

Underserved groups such as US veterans can face even greater challenges in gaining access to disease prevention programs. But the introduction of health-based technology may have the power to shift the trajectory of such populations. A new study led by Tannaz Moin, MD, MBA, MSHS, assistant professor of medicine, University of California, Los Angeles (UCLA), found online diabetes prevention programs (DPPs) faired just as effective as in-person DPPs, implying an intensive, multifaceted online DPP could as effectively serve patients with an expanded reach.

In an interview with MD Magazine®, Moin said 22 in-person DPP sessions per year may not be convenient or event feasible for patients.

“That prompted us to test an online DPP, which provides flexibility and convenience through asynchronously delivery to address some well-known barriers to DPP participation,” Moin said. The investigators’ goal was to assess the effectiveness of online DPP, and to also compare results to an in-person DPP and the standard of care weight loss program in the US Department of Veterans Affairs (VA) known as ‘MOVE!.’

Between 2013 and 2014, obese/overweight veterans with prediabetes enrolled in an online DPP (n = 268). The in-person DPP shared similar eligibility criteria, which included 387 participants (273 to in-person DPP; 114 to MOVE!) between 2012 and 2014 within a separate trial.

The online DPP included a virtual group format, weekly asynchronous live coaching modules, and wireless home scales. The in-person programs included 8-22 group-based, face-to-face sessions.

The online DPP, developed by OmadaHealth, placed patients into small, closed online groups with trained coaches, Moin noted. They were able post online messages to their group and also message or speak to their coach by phone, in pursuit of achieving group-based goals.

“There are many online DPP products available on the general market, and the program we tested was an intensive and multifaceted program,” Moin said.

Moin also highlighted the diverse representation of racial/ethnic backgrounds and geographically located sites in the study, with 24% of the online DPP participants being African American/Black and 11% being Hispanic. “The study was based in the VA so there were more male than female participants, but men have been traditionally underrepresented in DPP translational studies,” Moine added.

Main outcome measures included weight change at 6 and 12 months using wirelessly uploaded home scale data or electronic medical record weights from clinical in-person visits, which were analyzed between 2015 and 2017.

Among the 268 (23%) participants who enrolled in the online DPP, 158 (56%) completed 8 or more modules, reporting a mean weight change of −4.7 kg at 6 months and −4.0 kg at 12 months. Of participants completing 1 or more sessions/modules in a supplemental analysis, 8 or more sessions/modules were likely to be completed by online DPP participants (87% online DPP vs 59% in-person DPP vs 55% MOVE! [P < 0.001]).

By Moine’s count, this was one of the first studies to rigorously evaluate an online DPP while comparing it to in-person programs. She and her team concluded that intensive, multifaceted online DPP interventions may as effective as in-person DPPs, with the added capability to expand their reach inaccessible at-risk patients.

With the data reflecting equal efficacy and higher participation, it only further weighs in on the debating regarding electronic health records and the characteristics by which they may be considered either helpful tools or burdensome deterrents.

“Veterans receiving care in the VA are more likely to have lower socioeconomic status and online DPP participation led to clinically meaningful weight loss in this study,” Moine added. “Based on these findings, I would say that it is possible to consider translating online DPP for other underserved populations as well.”

Looking forward, Moine said it would ideal for key stakeholders, including health systems, payers, and patients to consider ways in which they can collaboratively work to increase access and coverage for online DPP.

Since there is also a growing interest in the remote delivery of healthcare services in general, Moine expressed the importance of testing interventions prior to wide scale. However, the more that the delivery of prevention services for patients can be conveniently and flexibly delivered, at-risk populations are more likely to be engaged and the health of the population is more likely to be impacted at large.

“We know that about half of US adults now has either diabetes or prediabetes, so this seems like a critical area for us to make some major headway,” Moine closed.

The study, "Results From a Trial of an Online Diabetes Prevention Program Intervention," was published online in the American Journal of Preventive Medicine.