WHAT ARE THE EVIDENCE-BASED PRINCIPLES THAT LEAD TO SUCCESSFUL TECHNOLOGY-ENABLED DIABETES SELF-MANAGEMENT SUPPORT INTERVENTIONS

Neal Kaufman, MD, MPH (DPS Health, Los Angeles, CA)

Dr. Kaufman discussed the components of an effective self-management support intervention, with a nod to DPS’s Virtual Lifestyle Management service. The Virtual Lifestyle Management service is an online-based self-management support intervention, which includes a one-year educational program and behavior planning and tracking services. In an early trial, the service produced 4-5 kg (9-11 lbs) weight loss by three months, with maintenance out to 12 months. Dr. Kaufman indicated that due to such success, researchers at the University of Pittsburgh were adapting the service for the Air Force, with two randomized controlled trials set to complete in 2012.

·         There are ten elements of a self-management support intervention. These include identifying patients, encouraging participation, assessing baseline status, providing teaching, setting goals, motivating users toward goal attainment, measuring progress, receiving and providing social support, and offering coaching support. Both in his presentation and in the Q&A, Dr. Kaufman stressed that an intervention should not offer a variety of elements from which a user can pick but rather be targeted and designed to meet the patient’s needs as they progress over time. While numerous formats and communication channels are possible, he suggested designers should ensure the program is affordable and scalable.

·         The Virtual Lifestyle Management service is an online-based self-management support intervention. Launched in 2008, the service includes a one-year educational program (based on the DPP, including 16 weekly and eight monthly lessons with streaming audio and interactive workbooks) and behavior planning and tracking services. Users can also communicate with behavior coaches via email. Dr. Kaufman indicated that the program would be adapted for mobile phones soon.

·         Speaking to one of the principles put forth by Dr. Kaufman, the Virtual Lifestyle Management system is evidence-based. In an early trial, the service produced 4-5 kg (9-11 lbs) weight loss by three months, with maintenance out to 12 months. Dr. Kaufman indicated that due to such success, researchers at the University of Pittsburgh were adapting the service for the Air Force. Pittsburgh researchers are also conducting two randomized controlled trials of the service, set to complete in 2012.

Questions and Answers

Dr. Bruce Bode (Atlanta Diabetes Associates, Atlanta, GA): What is the cost per patient to enroll in such a program?

Dr. Kaufman: Our program if you look at the total cost is somewhere around $350 per patient.

Dr. Bode: How many are enrolled so far?

Dr. Kaufman: About 2,500, half with diabetes and half with prediabetes at 24 different sites.

Dr. Bode: Any data on A1c or blood pressure?

Dr. Kaufman: A trial showed positive results and is going to be submitted. The Pittsburgh trials are powered for that information as well.

Dr. Bode: How does this compare to Weight Watchers?

Dr. Kaufman: Part of the commercial products is they offer food. The fundamental difference is that this intervention is designed for a particular target population. If you look at Weight Watchers or WebMD they’re a set of tools that you can pick and choose from. Most likely, the people who do best on that are the ones who need it the least.

Dr. Richard Bergenstal (International Diabetes Center, Minneapolis, MN): This is in the important area of diabetes prevention. Is there any notion that it could be explored in type 2 diabetes?

Dr. Kaufman: In the program that I mentioned, about half have type 2 diabetes. It is not a diabetes management program; it’s lifestyle. But when they have diabetes, it’s clear it’s for diet and activity counseling, not diabetes care. It certainly could be developed using the same principles as an effective intervention.