Web-based program aids adults with prediabetes in lowering glycemic markers

Issue: July 2015

BOSTON – Adults with prediabetes who participated in an automated, Internet-based diabetes management program saw improvements in HbA1c, glycemic markers and weight loss, according to study findings presented here.

In a randomized controlled trial taking place over 6 months, researchers found that adults with prediabetes who participated in the Alive-PD program improved their glycemic profiles and reported better eating and exercise habits, with a majority of participants remaining engaged in the program throughout the study period.

“In terms of retention and engagement, that’s the big problem with all online programs, and we had very good engagement and retention,” Gladys Block, PhD, a professor emerita at the University of California Berkeley School of Public Health and a research scientist at NutritionQuest, said while presenting the findings at the American Diabetes Association’s 75th Scientific Sessions.

Gladys Block

Block and colleagues at other institutions analyzed data from 340 participants (mean age, 55 years; 68.5% male; 67% white) with prediabetes (identified either by fasting glucose or HbA1c level), all recruited through the Palo Alto Medical Foundation Research Institute. Participants had a mean BMI of 31.1, mean fasting glucose of 109.9 mg/dL, and mean HbA1c of 5.6%. Researchers randomized participants to begin the Alive-PD program either immediately or after a 6-month delay, and measured weight and glycemic markers at baseline and every 3 months.

The Alive-PD program, developed by NutritionQuest, a wellness research company in Berkeley, Ca., focuses on increasing physical activity and improving food habits through a customized Web page, tailored weekly e-mails and a mobile application. The automated “coaching tool” provides reminders about planning and scheduling diabetes maintenance, as well as social support. To sustain engagement, incentives including games and competitions based on a point system are built into the program, Block said.

After 6 months of treatment, participants in the Alive-PD group saw improvements in the endpoints of fasting glucose (P < .001), HbA1c (P < .02) and body weight (P < .0001). Researchers noted that changes were greatest among those originally classified as pre-diabetic rather than normoglycemic by HbA1c (n = 151). Those participants had a 4.8 mg/dL decrease in fasting glucose vs. -1.0 mg/dL in the control group; a 0.27% decrease in HbA1c vs. -0.18% in controls and an average 6.3 lb weight loss vs. 1 lb weight loss in the control group.

Among participants with an HbA1c level in the prediabetic range, 10.4% in the control group had an increase in HbA1c vs. only 2.7% of Alive-PD participants.

Over the 24-week study, participants interacted with the program an average of 17 weeks, accomplishing an average of 1.5 goals per week over that period, Block said. After 6 months, 71% of the cohort were still participating in the program.

“The randomized trial provides evidence of effectiveness in glycemic markers as well as – although I did not show this [during the presentation] – increases in physical activity and increases in [eating] fruits and vegetables and decreases in some of the things we would like them to decrease,” Block said. “So this program could be used as a supplement or complement program that you might have or to reach those who don’t come to your diabetes programs.”

Researchers hope to study the Alive-PD program further with a larger, more diverse sample, Block said.

“We also hope to explore the effectiveness of this low cost and commercially available program among individuals with newly-diagnosed diabetes,” the researchers wrote. – by Regina Schaffer

Reference:

Block G, et al. 213-OR. Presented at: American Diabetes Association’s 75th Scientific Sessions; June 5-9, 2015; Boston.

Disclosure: Block is a senior scientist and co-owner of NutritionQuest.