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Jahan E, Almansour R, Ijaz K, Baptista S, Giordan LB, Ronto R, Zaman S, O'Hagan E, Laranjo L. Smartphone Applications to Prevent Type 2 Diabetes: A Systematic Review and Meta-Analysis. Am J Prev Med 2024; 66:1060-1070. [PMID: 38272243 DOI: 10.1016/j.amepre.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Evidence supporting the use of apps for lifestyle behavior change and diabetes prevention in people at high risk of diabetes is lacking. The aim of this systematic review was to determine the acceptability and effectiveness of smartphone applications (apps) for the prevention of type 2 diabetes. METHODS PubMed, Embase, CINAHL and PsychInfo were searched from 2008 to 2023. Included studies involved adults at high risk of developing diabetes evaluating an app intervention with the aim of preventing type 2 diabetes. Random-effects meta-analyses were conducted for weight loss, body mass index (BMI), glycated hemoglobin, and waist circumference. Narrative synthesis was conducted for all studies, including qualitative studies exploring user perspectives. RESULTS Twenty-four studies (n=2,378) were included in this systematic review, including 9 randomized controlled trials (RCTs) with an average duration of 6 months, 10 quasi-experimental and 7 qualitative studies. Socially disadvantaged groups were poorly represented. Six RCTs were combined in meta-analyses. Apps were effective at promoting weight loss [mean difference (MD) -1.85; 95% CI -2.90 to -0.80] and decreasing BMI [MD -0.90, 95% CI -1.53 to -0.27], with no effect on glycated hemoglobin and waist circumference. No studies reported on diabetes incidence. Qualitative studies highlighted the need for app personalization. DISCUSSION Smartphone apps have a promising effect on preventing type 2 diabetes by supporting weight loss. Future robust trials should include diverse populations in co-design and evaluation of apps and explore the role of artificial intelligence in further personalizing interventions for higher engagement and effectiveness.
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Affiliation(s)
- Esrat Jahan
- Department of Health Systems and Population, Macquarie University, Sydney, NSW, Australia; Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rawan Almansour
- College of Applied Medical Sciences, King Faisal University, Al Ahsa, Saudi Arabia
| | - Kiran Ijaz
- Affective Interactions lab, School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia
| | - Shaira Baptista
- The Australian Centre for Behavioural Research in Diabetes, Deakin University and the University of Melbourne, Melbourne, Victoria, Australia
| | - Leticia Bezerra Giordan
- Northern Beaches Hospital, 105 French's Forest Rd W, French's Forest, Sydney, NSW, Australia
| | - Rimante Ronto
- Department of Health Systems and Population, Macquarie University, Sydney, NSW, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Edel O'Hagan
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Gaglia JL, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Selvin E, Stanton RC, Gabbay RA. 3. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S43-S51. [PMID: 38078581 PMCID: PMC10725807 DOI: 10.2337/dc24-s003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Kepper M, Stamatakis KA, Mudd N, Deitch A, Terhaar A, Liu J, Gates E, Williams B, Cole G, French CS, Hampton A, Eyler A. A Communitywide Collaboration to Increase Enrollment, Retention, and Success in Evidence-Based Lifestyle-Change Programs in Racial and Ethnic Minority Populations. Prev Chronic Dis 2023; 20:E67. [PMID: 37535902 PMCID: PMC10431923 DOI: 10.5888/pcd20.220352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
PURPOSE AND OBJECTIVES Chronic diseases (eg, diabetes, hypertension) are the leading causes of death in the US and disproportionally affect racial and ethnic minority populations. This disparity is partially due to the unequal burden of unmet social needs that stem from several factors, including racism. INTERVENTION APPROACH The Alliance is a collaboration among health care, public health, and community organizations formed to improve referral, enrollment, and successful completion of evidence-based lifestyle-change programs, particularly among Black people. The Alliance built 1) a system to assess and address social barriers through the screening and referral process and 2) a training center for frontline staff (eg, community health workers). EVALUATION METHODS From January 2020 through September 2022, we conducted an evaluation that included both quantitative and qualitative methods. We developed an electronic database to make referrals and track key barriers to participation. Additionally, we conducted a focus group among frontline staff (N = 15) to understand the challenges in making referrals and discussing, documenting, and addressing barriers to participation. We used surveys that collected quantitative and open-ended qualitative responses to evaluate the training center and to understand perceptions of training modules as well as the skills gained. RESULTS Frontline staff engaged with 6,036 people, of whom 847 (14%) were referred to a lifestyle-change program from January 2020 through September 2022. Of those referred, 257 (30%) were eligible and enrolled in a program. Food access and unreliable internet were the most common barriers to participation. Thirteen of 15 frontline staff participated in trainings, and, on average, trainees completed 4.2 trainings and gained several skills (eg, ability to monitor personal bias, de-escalate a crisis, educate on mental health, understand community and environmental factors). IMPLICATIONS FOR PUBLIC HEALTH The Alliance is an example of how health care, public health, and community partners can work together to increase enrollment in lifestyle-change programs of residents disproportionately affected by chronic diseases. Lessons learned from implementation and evaluation can inform other complex partnerships to improve public health.
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Affiliation(s)
- Maura Kepper
- Prevention Research Center, Washington University in St. Louis, 1 Brookings Dr, Campus Box 1196, St. Louis, MO 63130
| | - Katherine A Stamatakis
- College for Public Health and Social Justice, Washington University in St. Louis, St. Louis, Missouri
| | - Natalie Mudd
- Prevention Research Center, Washington University in St. Louis, St. Louis, Missouri
| | - Ariel Deitch
- Prevention Research Center, Washington University in St. Louis, St. Louis, Missouri
| | - Ally Terhaar
- College for Public Health and Social Justice, Washington University in St. Louis, St. Louis, Missouri
| | - Julia Liu
- Prevention Research Center, Washington University in St. Louis, St. Louis, Missouri
| | - Emerald Gates
- St. Louis County Department of Public Health, St. Louis, Missouri
| | - Bobie Williams
- City of St. Louis Department of Health, St. Louis, Missouri
| | | | | | - Amy Hampton
- Missouri Department of Health and Senior Services, Bureau of Cancer and Chronic Disease Prevention, Jefferson City, Missouri
| | - Amy Eyler
- Prevention Research Center, Washington University in St. Louis, St. Louis, Missouri
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Yeh MC, Lau W, Keady CA, Horlyck-Romanovsky M, Tung HJ, Hu L, Ma GX, Wylie-Rosett J. Evaluation of feasibility and acceptability of a web-based diabetes prevention program (DPP) for diabetes risk reduction in Chinese Americans in New York City. Front Public Health 2023; 11:1199746. [PMID: 37333528 PMCID: PMC10272575 DOI: 10.3389/fpubh.2023.1199746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Intensive lifestyle intervention remains an effective modality to reduce diabetes incidence and delay the progression to type 2 diabetes. The primary aim of this study was to pilot-test the feasibility and acceptability of a culturally and linguistically tailored web-based DPP intervention among Chinese Americans with prediabetes living in New York City. Methods Thirteen Chinese American participants with prediabetes were recruited to complete a 1-year web-based Diabetes Prevention Program (DPP) lifestyle intervention. Quantitative and qualitative measures such as retention rate and data collected from web-based questionnaires and focus groups were collected and analyzed to assess study feasibility and acceptability. Results and Discussion Participants were receptive to the program through high engagement, retention and satisfaction. Retention rate was 85%. 92% of participants completed at least 16 sessions out of 22 sessions. Post-trial surveys indicated high satisfaction of 27.2/32 based on Client Satisfaction Questionnaire (CSQ-8) score. Participants expressed the program increased their knowledge and methods to prevent onset of type 2 diabetes such as incorporating healthy eating habits and increasing physical activities. Although not a primary outcome, there was a significant weight reduction of 2.3% at the end of month 8 of the program (p < 0.05). The culturally and linguistically adapted DPP via online platform successfully demonstrated feasibility and acceptability among Chinese Americans with prediabetes. Further evaluation of the web-based Chinese Diabetes Prevention Program in a larger trial is warranted.
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Affiliation(s)
- Ming-Chin Yeh
- Nutrition Program, School of Urban Public Health, Hunter College, City University of New York, New York, NY, United States
| | - Wincy Lau
- Nutrition Program, School of Urban Public Health, Hunter College, City University of New York, New York, NY, United States
| | - Claire Anselmo Keady
- Nutrition Program, School of Urban Public Health, Hunter College, City University of New York, New York, NY, United States
| | - Margrethe Horlyck-Romanovsky
- Department of Health and Nutrition Sciences, Brooklyn College, City University of Brooklyn, New York, NY, United States
| | - Ho-Jui Tung
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, United States
| | - Lu Hu
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
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Hill J, Faber M, Peer N, George C, Oldenburg B, Kengne AP. Adapting and Developing A Diabetes Prevention Intervention Programme for South Africa: Curriculum and Tools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4463. [PMID: 36901472 PMCID: PMC10002357 DOI: 10.3390/ijerph20054463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
The South African Diabetes Prevention Programme (SA-DPP) is a lifestyle intervention targeting individuals at high risk of developing type 2 diabetes mellitus (T2DM). In this paper we describe the mixed-method staged approach that was used to develop and refine the SA-DPP intervention curriculum and the appropriate tools for local resource-poor communities. During the preparation phase, existing evidence on similar DPP interventions was reviewed, focus group discussions with individuals from the target population were conducted as part of a needs assessment, and experts were consulted. The curriculum booklet, a participant workbook and facilitator workbook were developed, and the content was evaluated by experts in the field. The design and layout of the booklet and workbooks needed to be culturally and contextually appropriate. The printed material was evaluated for readability and acceptability by participants of the target population; based on their feedback, the design and layout were refined and the printed material was translated. The suitability of the intervention was tested in a pilot study; based on feedback from the participants and facilitator, the curriculum was revised where needed and finalised. Through this process a context specific intervention and printed materials were developed. A complete evaluation of this culturally relevant model for T2DM prevention in South Africa is pending.
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Affiliation(s)
- Jillian Hill
- Non-Communicable Diseases Research Unit, South African Medical Research Council (SAMRC), Cape Town 7505, South Africa
| | - Mieke Faber
- Non-Communicable Diseases Research Unit, South African Medical Research Council (SAMRC), Cape Town 7505, South Africa
- Center of Excellence for Nutrition, North-West University, Potchefstroom 2531, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council (SAMRC), Cape Town 7505, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
| | - Cindy George
- Non-Communicable Diseases Research Unit, South African Medical Research Council (SAMRC), Cape Town 7505, South Africa
| | - Brian Oldenburg
- Baker Heart and Diabetes Institute, School of Psychology and Public Health, La Trobe University, Victoria 3004, Australia
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council (SAMRC), Cape Town 7505, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
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Mastoris I, DeFilippis EM, Martyn T, Morris AA, Van Spall HG, Sauer AJ, J Sauer A. Remote Patient Monitoring for Patients with Heart Failure: Sex- and Race-based Disparities and Opportunities. Card Fail Rev 2023; 9:e02. [PMID: 36891178 PMCID: PMC9987513 DOI: 10.15420/cfr.2022.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/16/2022] [Indexed: 02/05/2023] Open
Abstract
Remote patient monitoring (RPM), within the larger context of telehealth expansion, has been established as an effective and safe means of care for patients with heart failure (HF) during the recent pandemic. Of the demographic groups, female patients and black patients are underenrolled relative to disease distribution in clinical trials and are under-referred for RPM, including remote haemodynamic monitoring, cardiac implantable electronic devices (CIEDs), wearables and telehealth interventions. The sex- and race-based disparities are multifactorial: stringent clinical trial inclusion criteria, distrust of the medical establishment, poor access to healthcare, socioeconomic inequities, and lack of diversity in clinical trial leadership. Notwithstanding addressing the above factors, RPM has the unique potential to reduce disparities through a combination of implicit bias mitigation and earlier detection and intervention for HF disease progression in disadvantaged groups. This review describes the uptake of remote haemodynamic monitoring, CIEDs and telehealth in female patients and black patients with HF, and discusses aetiologies that may contribute to inequities and strategies to promote health equity.
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Affiliation(s)
- Ioannis Mastoris
- Cardiology Division, Department of Medicine, Massachusetts General Hospital Boston, Massachusetts, US
| | | | - Trejeeve Martyn
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic Ohio, US
| | - Alanna A Morris
- Department of Medicine, Emory University School of Medicine Georgia, US
| | - Harriette Gc Van Spall
- Department of Medicine, Department of Health Research Methods, Evidence and Impact, McMaster University Hamilton, Canada.,Population Health Research Institute and Research Institute of St Joseph's Hamilton, Canada
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City Kansas City, Missouri, US
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 3. Prevention or Delay of Type 2 Diabetes and Associated Comorbidities: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S41-S48. [PMID: 36507633 PMCID: PMC9810464 DOI: 10.2337/dc23-s003] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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8
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Ahmad E, Lim S, Lamptey R, Webb DR, Davies MJ. Type 2 diabetes. Lancet 2022; 400:1803-1820. [PMID: 36332637 DOI: 10.1016/s0140-6736(22)01655-5] [Citation(s) in RCA: 182] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/10/2022] [Accepted: 08/19/2022] [Indexed: 11/06/2022]
Abstract
Type 2 diabetes accounts for nearly 90% of the approximately 537 million cases of diabetes worldwide. The number affected is increasing rapidly with alarming trends in children and young adults (up to age 40 years). Early detection and proactive management are crucial for prevention and mitigation of microvascular and macrovascular complications and mortality burden. Access to novel therapies improves person-centred outcomes beyond glycaemic control. Precision medicine, including multiomics and pharmacogenomics, hold promise to enhance understanding of disease heterogeneity, leading to targeted therapies. Technology might improve outcomes, but its potential is yet to be realised. Despite advances, substantial barriers to changing the course of the epidemic remain. This Seminar offers a clinically focused review of the recent developments in type 2 diabetes care including controversies and future directions.
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Affiliation(s)
- Ehtasham Ahmad
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Roberta Lamptey
- Family Medicine Department, Korle Bu Teaching Hospital, Accra Ghana and Community Health Department, University of Ghana Medical School, Accra, Ghana
| | - David R Webb
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK.
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Saju R, Castellon-Lopez Y, Turk N, Moin T, Mangione CM, Norris KC, Vu A, Maranon R, Fu J, Cheng F, Duru OK. Differences in Weight Loss by Race and Ethnicity in the PRIDE Trial: a Qualitative Analysis of Participant Perspectives. J Gen Intern Med 2022; 37:3715-3722. [PMID: 35469358 PMCID: PMC9037581 DOI: 10.1007/s11606-022-07521-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many Diabetes Prevention Program (DPP) translation efforts have been less effective for underresourced populations. In the cluster-randomized Prediabetes Informed Decision and Education (PRIDE) trial, which evaluated a shared decision-making (SDM) intervention for diabetes prevention, Hispanic and non-Hispanic Black participants lost less weight than non-Hispanic White participants at 12-month follow-up. OBJECTIVE To explore perspectives about weight loss from PRIDE participants of different racial and ethnic groups. PARTICIPANTS Sample of participants with prediabetes who were randomized to the PRIDE intervention arm (n=24). APPROACH We conducted semi-structured interviews within three groups stratified by DPP participation and % weight loss at 12 months: (DPP+/WL+, enrolled in DPP and lost >5% weight; DPP+/WL-, enrolled in DPP and lost <3% weight; DPP-/WL-, did not enroll in DPP and lost <3% weight). Each group was further subdivided on race and ethnicity (non-Hispanic Black (NHB), non-Hispanic White (NHW), Hispanic). Interviews were conducted on Zoom and transcripts were coded and analyzed with Dedoose. KEY RESULTS Compared to NHW participants, Hispanic and NHB participants more often endorsed weight loss barriers of limited time to make lifestyle changes due to long work and commute hours, inconvenient DPP class locations and offerings, and limited disposable income for extra weight loss activities. Conversely, facilitators of weight loss regardless of race and ethnicity included retirement or having flexible work schedules; being able to identify convenient DPP classes; having a strong, positive support system; and purchasing supplementary resources to support lifestyle change (e.g., gym memberships, one-on-one activity classes). CONCLUSIONS We found that NHB and Hispanic SDM participants report certain barriers to weight loss more commonly than NHW participants, particularly barriers related to limited disposable income and/or time constraints. Our findings suggest that increased lifestyle change support and flexible program delivery options may be needed to ensure equity in DPP reach, participant engagement, and outcomes.
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Affiliation(s)
- Rintu Saju
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Yelba Castellon-Lopez
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Family Medicine, University of California, Los Angeles, CA, USA
| | - Norman Turk
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Tannaz Moin
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
- VA Greater Los Angeles Health System and HSR&D Center for Study of Healthcare Innovation, Implementation & Policy, University of California, Los Angeles, CA, USA
- Division of Endocrinology, Diabetes & Metabolism, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Carol M Mangione
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Keith C Norris
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Amanda Vu
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Richard Maranon
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Jeffery Fu
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Felicia Cheng
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - O Kenrik Duru
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA.
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Katula JA, Dressler EV, Kittel CA, Harvin LN, Almeida FA, Wilson KE, Michaud TL, Porter GC, Brito FA, Goessl CL, Jasik CB, Sweet CMC, Schwab R, Estabrooks PA. Effects of a Digital Diabetes Prevention Program: An RCT. Am J Prev Med 2022; 62:567-577. [PMID: 35151522 DOI: 10.1016/j.amepre.2021.10.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION In light of the need to expand the reach and access of clinically proven digital Diabetes Prevention Programs (d-DPPs) and the need for rigorous evidence of effectiveness, the purpose of this study was to determine the effectiveness of a digital Diabetes Prevention Program for improving weight, HbA1c, and cardiovascular risk factors among people with prediabetes compared to enhanced standard care plus waitlist control. STUDY DESIGN This was a single-blind RCT among participants at risk of developing type 2 diabetes and included 12 months of follow-up. SETTING/PARTICIPANTS A total of 599 volunteer patients with prediabetes were recruited primarily through electronic medical records and primary care practices. INTERVENTION Participants were randomized to either a d-DPP (n=299) or a single-session small-group diabetes-prevention education class (n=300) focused on action planning for weight loss. The d-DPPs consisted of 52 weekly sessions, lifestyle coaching, virtual peer support, and behavior tracking tools. MAIN OUTCOME MEASURES The primary outcome was a change in HbA1c from baseline to 12 months using intent-to-treat analyses. On the basis of multiple comparisons of endpoints, 95% CIs are presented and 2-sided p<0.025 was required for statistical significance. Secondary outcomes included body weight and cardiovascular disease risk factors. RESULTS Among 599 randomized participants (mean age=55.4 years, 61.4% women), 483 (80%) completed the study. The d-DPPs produced significantly greater reductions in HbA1c (0.08%, 95% CI= -0.12, -0.03) and percentage change in body weight (-5.5% vs -2.1%, p<0.001) at 12 months. A greater proportion of the d-DPPs group achieved a clinically significant weight loss ≥5% (43% vs 21%, p<0.001), and more participants shifted from prediabetes to normal HbA1c range (58% vs 48%, p=0.04). Engagement in d-DPPs was significantly related to improved HbA1c and weight loss. CONCLUSIONS This d-DPPs demonstrated clinical effectiveness and has significant potential for widespread dissemination and impact, particularly considering the growing demand for telemedicine in preventive healthcare services. TRIAL REGISTRATION This study is registered at www. CLINICALTRIALS gov (ClinicalTrials.gov Identifier: NCT03312764).
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Affiliation(s)
- Jeffrey A Katula
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, North Carolina.
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Carol A Kittel
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lea N Harvin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Fabio A Almeida
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kathryn E Wilson
- Department of Kinesiology and Health, College of Education & Human Development, Georgia State University, Atlanta, Georgia
| | - Tzeyu L Michaud
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Gwenndolyn C Porter
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Fabiana A Brito
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Cody L Goessl
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Carolyn B Jasik
- Medical Affairs, Omada Health, Inc., San Francisco, California
| | | | - Robert Schwab
- Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paul A Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
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Batten R, Alwashmi MF, Mugford G, Nuccio M, Besner A, Gao Z. A 12-Month Follow-Up of the Effects of a Digital Diabetes Prevention Program (VP Transform for Prediabetes) on Weight and Physical Activity Among Adults With Prediabetes: Secondary Analysis. JMIR Diabetes 2022; 7:e23243. [PMID: 35029532 PMCID: PMC8800085 DOI: 10.2196/23243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/20/2020] [Accepted: 11/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background The prevalence of diabetes is increasing rapidly. Previous research has demonstrated the efficacy of a diabetes prevention program (DPP) in lifestyle modifications that can prevent or delay the onset of type 2 diabetes among individuals at risk. Digital DPPs have the potential to use technology, in conjunction with behavior change science, to prevent prediabetes on a national and global scale. Objective The aim of this study is to investigate the effects of a digital DPP (Virgin Pulse [VP] Transform for Prediabetes) on weight and physical activity among participants who had completed 12 months of the program. Methods This study was a secondary analysis of retrospective data of adults with prediabetes who were enrolled in VP Transform for Prediabetes for 12 months of the program. The program incorporates interactive mobile computing, remote monitoring, an evidence-based curriculum, behavior tracking tools, health coaching, and online peer support to prevent or delay the onset of type 2 diabetes. Results The sample (N=1095) was comprised of people with prediabetes who completed at least 9 months of the VP Transform for Prediabetes program. Participants were 67.7% (n=741) female, with a mean age of 53.6 (SD 9.75) years. After 12 months, participants decreased their weight by an average of 10.9 lbs (5.5%; P<.001) and increased their physical activity by 91.2 (P<.001) minutes. Conclusions These results suggest that VP Transform for Prediabetes is effective at preventing type 2 diabetes through a significant reduction in body weight and increase of physical activity. Furthermore, these results suggest that the DPP remains effective 12 months after beginning the program. A prospective randomized controlled clinical study is warranted to validate these findings.
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Affiliation(s)
- Ryan Batten
- Memorial University of Newfoundland, St John's, NL, Canada
| | | | - Gerald Mugford
- Memorial University of Newfoundland, St John's, NL, Canada
| | | | | | - Zhiwei Gao
- Memorial University of Newfoundland, St John's, NL, Canada
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12
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3. Prevention or Delay of Type 2 Diabetes and Associated Comorbidities: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022; 45:S39-S45. [PMID: 34964876 DOI: 10.2337/dc22-s003] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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13
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Fitzpatrick SL, Mayhew M, Rawlings AM, Smith N, Nyongesa DB, Vollmer WM, Stevens VJ, Grall SK, Fortmann SP. Evaluating the Implementation of a Digital Diabetes Prevention Program in an Integrated Health Care Delivery System Among Older Adults: Results of a Natural Experiment. Clin Diabetes 2022; 40:345-353. [PMID: 35983414 PMCID: PMC9331625 DOI: 10.2337/cd21-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this natural experiment study was to assess the effectiveness of a 12-month digital Diabetes Prevention Program (DPP) for adults aged 65-75 years with prediabetes and obesity within a large, integrated health care system. Adjusting for propensity scores and covariates, patients who enrolled and participated in the digital DPP had a mean weight loss of 8.6 lb over 12 months and 5.7 lb by 24 months, compared with a steady, minimal weight loss of 1.3 lb over 12 months and 2.8 lb by 24 months among patients not enrolled. There was a significant difference in mean change in A1C between enrolled and nonenrolled patients over 12 months (-0.10%), but not by 24 months (-0.06%). Digital DPP appears to be an effective weight loss option and potential diabetes prevention intervention for older adults at high risk for type 2 diabetes.
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Affiliation(s)
| | - Meghan Mayhew
- Kaiser Permanente Center for Health Research, Portland, OR
| | | | - Ning Smith
- Kaiser Permanente Center for Health Research, Portland, OR
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14
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Cannon MJ, Ng BP, Lloyd K, Reynolds J, Ely EK. Delivering the National Diabetes Prevention Program: Assessment of Enrollment in In-Person and Virtual Organizations. J Diabetes Res 2022; 2022:2942918. [PMID: 35118160 PMCID: PMC8804550 DOI: 10.1155/2022/2942918] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/08/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of the US Centers for Disease Control and Prevention's (CDC) National Diabetes Prevention Program (National DPP) is to make an evidence-based lifestyle change program widely available to the more than 88 million American adults at risk for developing type 2 diabetes. The National DPP allows for program delivery using four delivery modes: in person, online, distance learning, and combination. The objective of this study was to analyze cumulative enrollment in the National DPP by delivery mode. We included all participants who enrolled in CDC-recognized organizations delivering the lifestyle change program between January 1, 2012, and December 31, 2019, and whose data were submitted to CDC's Diabetes Prevention Recognition Program. During this time, the number of participants who enrolled was 455,954. Enrollment, by delivery mode, was 166,691 for in-person; 269,004 for online; 4,786 for distance-learning; and 15,473 for combination. In-person organizations enrolled the lowest proportion of men (19.4%) and the highest proportions of non-Hispanic Black/African American (16.1%) and older (65+ years) participants (28.2%). Online organizations enrolled the highest proportions of men (27.1%), younger (18-44 years) participants (41.5%), and non-Hispanic White participants (70.3%). Distance-learning organizations enrolled the lowest proportion of Hispanic/Latino participants (9.0%). Combination organizations enrolled the highest proportions of Hispanic/Latino participants (37.3%) and participants who had obesity (84.1%). Most in-person participants enrolled in organizations classified as community-centered entities (41.4%) or medical providers (31.2%). Online and distance-learning participants were primarily enrolled (93.3% and 70.2%, respectively) in organizations classified as for-profit businesses or insurers. Participants in combination programs were enrolled almost exclusively in organizations classified as medical providers (89%). The National DPP has reached nearly half a million participants since its inception in 2012, but continued expansion is critical to stem the tide of type 2 diabetes among the many Americans at high risk.
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Affiliation(s)
- Michael J. Cannon
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Boon Peng Ng
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
- College of Nursing and Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | | | | | - Elizabeth K. Ely
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
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15
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Fitzpatrick SL, Mayhew M, Catlin CL, Firemark A, Gruß I, Nyongesa DB, O’Keeffe-Rosetti M, Rawlings AM, Smith DH, Smith N, Stevens VJ, Vollmer WM, Fortmann SP. Evaluating the Implementation of Digital and In-Person Diabetes Prevention Program in a Large, Integrated Health System: Natural Experiment Study Design. Perm J 2021; 26:21-31. [PMID: 35609151 PMCID: PMC9126549 DOI: 10.7812/tpp/21.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Implementation of a Diabetes Prevention Program (DPP) in both in-person and digital health-care settings has been increasing. The purpose of this article is to describe the protocol of a mixed-methods, natural experiment study designed to evaluate the implementation of DPP in a large, integrated health system. METHODS Kaiser Permanente Northwest patients who were 19 to 75 years with prediabetes (hemoglobin A1c or glycated hemoglobin, 5.7-6.4) and obesity (body mass index ≥ 30 kg/m2) were invited, via the Kaiser Permanente Northwest patient portal, to participate in the digital (n = 4124) and in-person (n = 2669) DPP during 2016 through 2018. Primary (weight) and secondary (hemoglobin A1c or glycated hemoglobin level) outcome data will be obtained from electronic health records. A cost-effectiveness analysis as well as qualitative interviews with patients (enrolled and not enrolled in the DPP) and stakeholders will be conducted to examine further implementation, acceptability, and sustainability. CONCLUSION The mixed-methods, natural experiment design we will use to evaluate Kaiser Permanente Northwest's implementation of the digital and in-person DPP builds on existing evidence related to the effectiveness of these two DPP delivery modes and will contribute new knowledge related to best practices for implementing and sustaining the DPP within large health systems over the long term.
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Affiliation(s)
| | - Meghan Mayhew
- Kaiser Permanente Center for Health Research in Portland, OR
| | - Chris L Catlin
- Kaiser Permanente Center for Health Research in Portland, OR
| | - Alison Firemark
- Kaiser Permanente Center for Health Research in Portland, OR
| | - Inga Gruß
- Kaiser Permanente Center for Health Research in Portland, OR
| | | | | | | | - David H Smith
- Kaiser Permanente Center for Health Research in Portland, OR
| | - Ning Smith
- Kaiser Permanente Center for Health Research in Portland, OR
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16
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Castela Forte J, Folkertsma P, Gannamani R, Kumaraswamy S, Mount S, de Koning TJ, van Dam S, Wolffenbuttel BHR. Development and Validation of Decision Rules Models to Stratify Coronary Artery Disease, Diabetes, and Hypertension Risk in Preventive Care: Cohort Study of Returning UK Biobank Participants. J Pers Med 2021; 11:1322. [PMID: 34945794 PMCID: PMC8707007 DOI: 10.3390/jpm11121322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/23/2021] [Accepted: 11/20/2021] [Indexed: 12/25/2022] Open
Abstract
Many predictive models exist that predict risk of common cardiometabolic conditions. However, a vast majority of these models do not include genetic risk scores and do not distinguish between clinical risk requiring medical or pharmacological interventions and pre-clinical risk, where lifestyle interventions could be first-choice therapy. In this study, we developed, validated, and compared the performance of three decision rule algorithms including biomarkers, physical measurements, and genetic risk scores for incident coronary artery disease (CAD), diabetes (T2D), and hypertension against commonly used clinical risk scores in 60,782 UK Biobank participants. The rules models were tested for an association with incident CAD, T2D, and hypertension, and hazard ratios (with 95% confidence interval) were calculated from survival models. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC), and Net Reclassification Index (NRI). The higher risk group in the decision rules model had a 40-, 40.9-, and 21.6-fold increased risk of CAD, T2D, and hypertension, respectively (p < 0.001 for all). Risk increased significantly between the three strata for all three conditions (p < 0.05). Based on genetic risk alone, we identified not only a high-risk group, but also a group at elevated risk for all health conditions. These decision rule models comprising blood biomarkers, physical measurements, and polygenic risk scores moderately improve commonly used clinical risk scores at identifying individuals likely to benefit from lifestyle intervention for three of the most common lifestyle-related chronic health conditions. Their utility as part of digital data or digital therapeutics platforms to support the implementation of lifestyle interventions in preventive and primary care should be further validated.
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Affiliation(s)
- José Castela Forte
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Ancora Health B.V., Herestraat 106, 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.M.); (S.v.D.)
| | - Pytrik Folkertsma
- Ancora Health B.V., Herestraat 106, 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.M.); (S.v.D.)
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Rahul Gannamani
- Ancora Health B.V., Herestraat 106, 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.M.); (S.v.D.)
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Sridhar Kumaraswamy
- Ancora Health B.V., Herestraat 106, 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.M.); (S.v.D.)
| | - Sarah Mount
- Ancora Health B.V., Herestraat 106, 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.M.); (S.v.D.)
| | - Tom J. de Koning
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Pediatrics, Department of Clinical Sciences, Lund University, Sölvegatan 19-BMC F12, 221 84 Lund, Sweden
| | - Sipko van Dam
- Ancora Health B.V., Herestraat 106, 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.M.); (S.v.D.)
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Bruce H. R. Wolffenbuttel
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
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17
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Sieczkowska SM, de Lima AP, Swinton PA, Dolan E, Roschel H, Gualano B. Health Coaching Strategies for Weight Loss: A Systematic Review and Meta-Analysis. Adv Nutr 2021; 12:1449-1460. [PMID: 33339042 DOI: 10.1093/advances/nmaa159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/01/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023] Open
Abstract
Health coaching has emerged as a potential supporting tool for health professionals to overcome behavioral barriers, but its efficacy in weight management remains unclear. We conducted a systematic review and meta-analysis to synthesize and evaluate the quality of evidence supporting the use of self-reported health coaching for weight loss. Seven electronic databases (PubMed, Web of Science, Scopus, Cochrane, Psyinfo, Virtual Health Library, and Scielo) were independently searched from inception to May 2020. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation recommendations. Any study that investigated a self-reported health coaching intervention with the goal of inducing weight loss in individuals of any age, health, or training status was considered for inclusion. Quantitative data were analyzed using multilevel hierarchical metaregression models conducted within a Bayesian framework. A total of 653 studies were screened and 38 were selected for inclusion. The quality of evidence supporting outcomes based on the entire evidence base was very low and studies were deemed to have high risk of bias. Meta-analysis of controlled studies provided evidence of an effect favoring coaching compared with usual care but was trivial in magnitude [effect size (ES)0.5: -0.09; 95% credible interval (CrI): -0.17, -0.02]. The multilevel extension of Egger's regression-intercept test indicated the existence of publication bias, whereas a sensitivity analysis based only on those studies deemed to be of high quality provided no evidence of an effect of coaching on weight loss (ES0.5: -0.04; 95% CrI: -0.12, 0.09). Considered collectively, the results of this investigation indicate that the available evidence is not of sufficient quality to support the use of self-reported health coaching as a health care intervention for weight loss. This trial was registered at Prospective Register of Systematic Reviews (PROSPERO) as CRD42020159023.
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Affiliation(s)
- Sofia Mendes Sieczkowska
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR
| | - Alisson Padilha de Lima
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR.,School of Physical Education, Faculty IELUSC, Joinville-SC, BR
| | - Paul Alan Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, United Kingdom
| | - Eimear Dolan
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR
| | - Hamilton Roschel
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR
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18
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Roszak SE, Ferreri SP. Community Pharmacy Engagement in Diabetes Prevention: Key Informant Interviews with Pharmacy Executives. Prev Chronic Dis 2020; 17:E90. [PMID: 32816661 PMCID: PMC7458117 DOI: 10.5888/pcd17.200050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Even though evidence-based diabetes prevention interventions exist, more than 1 in 3 Americans have prediabetes; the use of pharmacies has been explored as a way to reach and care for this population. The objective of this study was to analyze factors that influence adoption of type 2 diabetes prevention programs by community pharmacies. Methods We conducted 21 semistructured interviews in 2018 with decision makers from 11 independent pharmacies in 6 US states and the District of Columbia and from 10 chain pharmacies operating in 1 state, multiple states, and nationwide. We identified participants by using purposive sampling. We used qualitative methods to analyze data and conducted interviews until we reached saturation. Results Multiple themes emerged: 1) initiation of services is more likely if initial financial support is received; 2) patient demand for services, actual or perceived, is paramount; 3) diabetes prevention services often fit within the existing operations of a pharmacy and allow maximum use of resources; 4) customer loyalty is a clearly articulated advantage against competition; and 5) engagement in diabetes prevention affirms an expanded role and the value of pharmacies to serve communities. Conclusion Pharmacies are well situated to deliver diabetes prevention programs to communities. Although considerable opportunity exists for pharmacies to address diabetes prevention, more could be done to reduce barriers to their use.
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Affiliation(s)
- Sara E Roszak
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina.,UNC Eshelman School of Pharmacy, Division of Practice Advancement and Clinical Education, 301 Pharmacy Lane, CB#7355, Chapel Hill, NC 27599-7355.
| | - Stefanie P Ferreri
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
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Weerahandi H, Paul S, Quintiliani LM, Chokshi S, Mann DM. A Mobile Health Coaching Intervention for Controlling Hypertension: Single-Arm Pilot Pre-Post Study. JMIR Form Res 2020; 4:e13989. [PMID: 32379049 PMCID: PMC7243130 DOI: 10.2196/13989] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 12/23/2019] [Accepted: 03/22/2020] [Indexed: 01/22/2023] Open
Abstract
Background The seminal Dietary Approaches to Stopping Hypertension (DASH) study demonstrated the effectiveness of diet to control hypertension; however, the effective implementation and dissemination of its principles have been limited. Objective This study aimed to determine the feasibility and effectiveness of a DASH mobile health intervention. We hypothesized that combining Bluetooth-enabled data collection, social networks, and a human coach with a smartphone DASH app (DASH Mobile) would be an effective medium for the delivery of the DASH program. Methods We conducted a single-arm pilot study from August 2015 through August 2016, using a pre-post evaluation design to evaluate the feasibility and preliminary effectiveness of a smartphone version of DASH that incorporated a human health coach. Participants were recruited both online and offline. Results A total of 17 patients participated in this study; they had a mean age of 59 years (SD 6) and 10 (60%) were women. Participants were engaged with the app; in the 120 days of the study, the mean number of logged blood pressure measurements was 63 (SD 46), the mean number of recorded weight measurements was 52 (SD 45), and participants recorded a mean of 55 step counts (SD 36). Coaching phone calls had a high completion rate (74/102, 73%). The mean number of servings documented per patient for the dietary assessment was 709 (SD 541), and patients set a mean number of 5 (SD 2) goals. Mean systolic and diastolic blood pressure, heart rate, weight, body mass index, and step count did not significantly change over time (P>.10 for all parameters). Conclusions In this pilot study, we found that participants were engaged with an interactive mobile app that promoted healthy behaviors to treat hypertension. We did not find a difference in the physiological outcomes, but were underpowered to identify such changes.
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Affiliation(s)
- Himali Weerahandi
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Soaptarshi Paul
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Lisa M Quintiliani
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Sara Chokshi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Devin M Mann
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States.,Medical Center Information Technology, NYU Langone Health, New York, NY, United States
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