Engagement and outcomes in a digital Diabetes Prevention Program: 3-year update

Abstract

ObjectiveTranslations of the Diabetes Prevention Program (DPP) have proliferated in recent years, with increasing expansion to digital formats. Although these DPP translations have consistently shown favorable clinical outcomes, long-term data for digital formats are limited. This study’s objective was to examine clinical outcomes up to 3 years post-baseline and the relationship between program engagement and clinical outcomes in a digital DPP.Research design and methodsIn a single-arm, non-randomized trial, 220 patients previously diagnosed with prediabetes were enrolled in the Omada Health Program, a commercially available, 16-week DPP-based weight loss intervention followed by an ongoing weight maintenance intervention. Changes in body weight and A1c were assessed annually. Relationships between program engagement during the first year and clinical outcomes across 3 years were examined.ResultsParticipants were socioeconomically diverse (62% women, 50.2% non-Hispanic white, 51.7% college educated or higher). From baseline to 3 years, those participants who completed four or more lessons and nine or more lessons achieved significant sustained weight loss (–3.0% and –2.9%, respectively) and an absolute reduction in A1c (–0.31 and –0.33, respectively) with an average remission from the prediabetes range to the normal glycemic range. Factor analysis of engagement metrics during the first year revealed two underlying dimensions, one comprising lesson completion and health behavior tracking consistency, and the other comprising website logins and group participation. When these two factors were used to predict weight loss, only the logins and group participation factor was a significant predictor of weight loss at 16 weeks and 1 year.ConclusionsThis study demonstrates significant long-term reductions in body weight and A1c in a digital DPP and identifies patterns of program engagement that predict weight loss.

Implementing an Online Weight‐Management Intervention to an Employee Population: Initial Experience with Real Appeal

“…Depending on the type of cohort analyzed, 23% to 36% of the participants lost 5% or more of their body weight, which is similar to the range of 18% to 34% reported by O’Neil et al who examined the impact of adding telephonic and email counseling from a diabetes educator alongside an in‐person commercial weight‐loss program . The participants in Real Appeal also had similar results reported in a digital DPRP program , with the major difference being the size of the study samples being compared. Many studies examining the effectiveness of commercial weight‐loss programs or digital DPP programs have reported on samples of less than 500 participants.…”

“…The ability of Real Appeal to engage with 52,461 weight-loss participants during a 12-month period was remarkable. These participants had outcomes similar to those reported by other commercial weightloss programs (19,20) and digital DPP programs (21). When assessing the effectiveness of a DPP program, the CDC examines the average number of sessions attended by program participants, with an average of nine sessions required to achieve full CDC DPRP recognition (10).…”

“…The participants in Real Appeal also had similar results reported in a digital DPRP program (21), with the major difference being the size of the study samples being compared. Many studies examining the effectiveness of commercial weight-loss programs (18)(19)(20) or digital DPP programs (21) have reported on samples of less than 500 participants. This analysis had 38,836 active participants and 27,164 program completers compared with 187 active participants and 155 program completers examined by Sepah et al, who measured weight loss on 220 participants from a digital DPP-based weight-loss program (20).…”

A Randomised Controlled Trial of a Digital Therapy for Diabetes Prevention Among High Risk Individual: Study Protocol (the Mydipp Trial)

“…[15,16,17] To overcome these problems, some intervention approaches integrate human coaching into technology using phone or email to enable wider reach, known as digital therapy. It is considered as a scalable method to reach a larger population who are at risk, [18] convenient and accessible. The purpose of this article is to present the MyDiPP study protocol.…”

“…At their convenience where the internet connection is available, participants completed the weekly curriculum lessons on lifestyle and behavioural change, communicate with the health coach and/or groupmates, self-monitor their diet and physical activity, and view their weight loss progress. [18,23,24] The participants are encouraged to aim for a minimum of 5-7% weight loss of their starting weight at 6month and keep working to lose weight if they have not reached the target until month 12. Participants are also encouraged to increase their physical activity to a minimum of 150 minutes per week and aim for moderate-intensity exercises.…”