Examining a Remote Group-Based Type 2 Diabetes Self-Management Education Program in the COVID-19 Era Using the ORBIT Model: Small 6-Week Feasibility Study (Preprint)

Abstract

BACKGROUND To date, most group-based type 2 diabetes (T2D) self-management education (DSME) programs have been delivered in-person. The rapid transition to virtual care at the outset of the COVID-19 pandemic presented opportunities to test, evaluate, and iterate a new virtual DSME program. OBJECTIVE To refine the delivery and evaluation of a multi-component virtual DSME program for adults living with T2D by examining several feasibility outcomes. METHODS Patients from a London, Canada outpatient diabetes clinic (serving high-risk, low-income adults) were recruited to participate in a six-week, single cohort feasibility study (ORBIT Phase 1b) from November 2020 to March 2021. A virtual DSME program including live video education classes, individualized physical activity (PA) prescription and counselling, as well as intermittently scanned continuous glucose and wearable PA monitoring was delivered. Several outcomes were assessed including recruitment and retention rates, program adherence, and acceptability (i.e., technology issues, exit survey feedback). PA was assessed with a FitBit Inspire 2 and estimated glycated hemoglobin (A1C) using the FreeStyle Libre. Given the small sample, data are reported descriptively and at the group and participant level. RESULTS Ten adults living with T2D were recruited (% female: 60, Age: 49.9±14.3 years, estimated A1C: 6.2±0.5%). Recruitment and retention rates were 29% and 80%, respectively. Participants attended 83% and 93% of education classes and PA counselling phone calls, respectively. There were 3.2±2.6 technology issues reported per person, mostly related to study data transfer. Exit survey responses suggest most participants (89%) were ‘satisfied’ with the program. Participants achieved 7103±2900 and 7515±3169 steps per day at baseline and Study Week 6, respectively. Estimated A1C was 6.2±0.5% and 6.2±0.6% at baseline and Study Week 6, respectively. CONCLUSIONS Though the virtual DSME program showed promise, several program and study protocol refinements are recommended before conducting a larger pilot trial (ORBIT Phase 2a). CLINICALTRIAL ClinicalTrials.gov NCT04498819