Diabetes Engagement and Activation Platform for Implementation and Effectiveness of Automated Virtual Type 2 Diabetes Self-Management Education: Randomized Controlled Trial

Roy Sabo, Jo Robins, Stacy Lutz, Paulette Kashiri, Teresa Day, Benjamin Webel, Alex Krist, Roy Sabo, Jo Robins, Stacy Lutz, Paulette Kashiri, Teresa Day, Benjamin Webel, Alex Krist

Abstract

Background: Patients with type 2 diabetes require recommendations for self-management education and support.

Objective: In this study, we aim to design the Diabetes Engagement and Activation Platform (DEAP)-an automated patient education tool integrated into primary care workflow-and examine its implementation and effectiveness.

Methods: We invited patients aged 18-85 years with a hemoglobin A1c (HbA1c) level ≥8 to participate in a randomized controlled trial comparing DEAP with usual care. DEAP modules addressing type 2 diabetes self-management education and support domains were programmed into patient portals, each with self-guided educational readings, videos, and questions. Care teams received patient summaries and were alerted to patients with low confidence or requesting additional help. HbA1c, BMI, and systolic and diastolic blood pressure (DBP) were measured.

Results: Out of the 680 patients invited to participate, 337 (49.5%) agreed and were randomized. All of the 189 intervention patients accessed the first module, and 140 patients (74.1%) accessed all 9 modules. Postmodule knowledge and confidence scores were high. Only 18 patients requested additional help from the care team. BMI was lower for intervention patients than controls at 3 months (31.7 kg/m2 vs 32.1 kg/m2; P=.04) and 6 months (32.5 kg/m2 vs 33.0 kg/m2; P=.003); improvements were even greater for intervention patients completing at least one module. There were no differences in 3- or 6-month HbA1c or blood pressure levels in the intent-to-treat analysis. However, intervention patients completing at least one module compared with controls had a better HbA1c level (7.6% vs 8.2%; P=.03) and DBP (72.3 mm Hg vs 75.9 mm Hg; P=.01) at 3 months.

Conclusions: The findings of this study concluded that a significant proportion of patients will participate in an automated virtual diabetes self-management program embedded into patient portals and health systems show promise in helping patients manage their diabetes, weight, and blood pressure.

Trial registration: ClinicalTrials.gov NCT02957721; https://ichgcp.net/clinical-trials-registry/NCT02957721.

Keywords: informatics; patient engagement; self-management education; type 2 diabetes mellitus.

Conflict of interest statement

Conflicts of Interest: None declared.

©Roy Sabo, Jo Robins, Stacy Lutz, Paulette Kashiri, Teresa Day, Benjamin Webel, Alex Krist. Originally published in JMIR Diabetes (http://diabetes.jmir.org), 29.03.2021.

Figures

Figure 1
Figure 1
CONSORT (Consolidated Standards of Reporting Trials) flow diagram.

References

    1. Centers for Disease Control and Prevention National Diabetes Statistics Report, 2020. 2020. [2021-03-05]. .
    1. American Diabetes Association 1. Improving care and promoting health in populations: standards of medical care in diabetes - 2020. Diabetes Care. 2020 Jan;43(Suppl 1):S7–S13. doi: 10.2337/dc20-S001.
    1. Huang ES, Basu A, O'Grady M, Capretta JC. Projecting the future diabetes population size and related costs for the U.S. Diabetes Care. 2009 Dec 25;32(12):2225–9. doi: 10.2337/dc09-0459.
    1. Quinn CC, Shardell MD, Terrin ML, Barr EA, Ballew SH, Gruber-Baldini AL. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care. 2011 Sep 25;34(9):1934–42. doi: 10.2337/dc11-0366.
    1. Duncan I, Ahmed T, Li Q, Stetson B, Ruggiero L, Burton K, Rosenthal D, Fitzner K. Assessing the value of the diabetes educator. Diabetes Educ. 2011 Aug 30;37(5):638–57. doi: 10.1177/0145721711416256.
    1. Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002 Jul 01;25(7):1159–71. doi: 10.2337/diacare.25.7.1159.
    1. Pereira K, Phillips B, Johnson C, Vorderstrasse A. Internet delivered diabetes self-management education: a review. Diabetes Technol Ther. 2015 Jan;17(1):55–63. doi: 10.1089/dia.2014.0155.
    1. Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, Maryniuk MD, Siminerio L, Vivian E. Diabetes self-management education and support in type 2 diabetes. Diabetes Educ. 2017 Feb 24;43(1):40–53. doi: 10.1177/0145721716689694.
    1. American Diabetes Association 5. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes-2020. Diabetes Care. 2020 Jan;43(Suppl 1):S48–S65. doi: 10.2337/dc20-S005.
    1. Peyrot M, Rubin RR, Funnell MM, Siminerio LM. Access to diabetes self-management education: results of national surveys of patients, educators, and physicians. Diabetes Educ. 2009 Feb 09;35(2):246–8, 52. doi: 10.1177/0145721708329546.
    1. El-Gayar O, Timsina P, Nawar N, Eid W. A systematic review of IT for diabetes self-management: are we there yet? Int J Med Inform. 2013 Aug;82(8):637–52. doi: 10.1016/j.ijmedinf.2013.05.006.
    1. Kaufman N. Internet and information technology use in treatment of diabetes. Int J Clin Pract Suppl. 2010 Feb;166(166):41–6. doi: 10.1111/j.1742-1241.2009.02277.x.
    1. Krist AH, Woolf SH, Frazier CO, Johnson RE, Rothemich SF, Wilson DB, Devers KJ, Kerns JW. An electronic linkage system for health behavior counseling effect on delivery of the 5A's. Am J Prev Med. 2008 Nov;35(5 Suppl):S350–8. doi: 10.1016/j.amepre.2008.08.010.
    1. Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. J Am Med Assoc. 2002 Nov 20;288(19):2469–75. doi: 10.1001/jama.288.19.2469.
    1. Hirst JA, Stevens RJ, Farmer AJ. Changes in HbA1c level over a 12-week follow-up in patients with type 2 diabetes following a medication change. PLoS One. 2014 Mar 25;9(3):-. doi: 10.1371/journal.pone.0092458.
    1. Facing today’s challenges in diabetes education. Healio Endocrine Today. [2021-03-05]. .
    1. Formosa C, Muscat R. Improving diabetes knowledge and self-care practices. J Am Podiatr Med Assoc. 2016 Sep 02;106(5):352–6. doi: 10.7547/15-071.
    1. US Preventive Services Task Force. Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Grossman DC, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Phipps MG, Silverstein M, Simon MA, Tseng CW, Wong JB. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US preventive services task force recommendation statement. J Am Med Assoc. 2018 Sep 18;320(11):1163–71. doi: 10.1001/jama.2018.13022.
    1. Amante DJ, Hogan TP, Pagoto SL, English TM. A systematic review of electronic portal usage among patients with diabetes. Diabetes Technol Ther. 2014 Nov;16(11):784–93. doi: 10.1089/dia.2014.0078.
    1. Marincic PZ, Hardin A, Salazar MV, Scott S, Fan SX, Gaillard PR. Diabetes self-management education and medical nutrition therapy improve patient outcomes: a pilot study documenting the efficacy of registered dietitian nutritionist interventions through retrospective chart review. J Acad Nutr Diet. 2017 Aug;117(8):1254–64. doi: 10.1016/j.jand.2017.01.023.
    1. Ragucci KR, Fermo JD, Wessell AM, Chumney EC. Effectiveness of pharmacist-administered diabetes mellitus education and management services. Pharmacotherapy. 2005 Dec;25(12):1809–16. doi: 10.1592/phco.2005.25.12.1809.

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