‘Behaviorally enriched’ diabetes prevention program dramatically improves outcomes
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Compared with CDC data, a diabetes prevention program tailored to commercial drivers increased course completion by sevenfold and doubled physical activity and weight loss measures, according to two speakers.
In collaboration with the employer and the drivers’ union, researchers developed a behaviorally enriched diabetes prevention program based on the CDC-approved curriculum and also incorporating a validated digital assessment to better identify the specific behavioral and psychosocial needs of the employees.
“These guys have tough jobs,” presenter Garry Welch, PhD, chief scientific officer at Silver Fern Healthcare, told Healio. “They’re plowing the streets in winter. In the summer, it's very hot, and they're cutting the grass up and down the highway, paving roads. Their motivator is that they could lose their license hypothetically in the future if they develop type 2 diabetes, and require certain medications, like insulin, that make them more likely to be risky in their jobs.”
The researchers enrolled 97 commercial drivers with prediabetes (98% men; mean age, 48.9 years; 76% white; 13.6% Latino) in a yearlong diabetes prevention program. The drivers worked at 11 depots around the state. Participants met with health coaches in their depot groups and individually to target modifiable behavioral and psychosocial barriers to lifestyle change, including health literacy, meal planning and physical activity, mental health issues, bodily pain and poor sleep. The three main outcomes were physical activity, weight loss and attendance.
“This was not a typical DPP that the CDC has formalized into manuals and the program and certification. It was what we're calling ‘behaviorally enriched,’” Welch said. “There was quite a lot of innovation ... and things that were created to make it more engaging for the drivers.”
To encourage attendance, hour-long sessions were held at shift changes with the employer crediting participants with 15 minutes of work time for attending. Missed sessions could be made up with phone calls or digitally. Physical activity was recorded by fitness trackers, and participants competed to move small trucks around a map of the state representing each depot’s cumulative steps. Weight loss was illustrated by stacks of highway barrels.
Groups reviewed together menus from truck stops to identify healthy meals.
“Places that they had vouchers for often had poor options,” Welch said. “So [the health coaches] would work with them, and if there's nothing on the menu of a particular restaurant, they would tell the guys to go and say, ‘Look we come here a lot, and we need a couple of things on the menu.’”
At 1 year, 78.8% of participants had completed the program by attending at least 22 sessions compared with 10.4% of the CDC’s National Diabetes Prevention Program (DPP); 60.7% had lost at least 5% of their initial body weight compared with 35.5% of DPP participants; and 82% engaged in at least 150 minutes of physical activity per week compared with 41.8% of DPP participants.
Keys to success of the program, delivered by WellSpark Health, were the active engagement of the employer and union leadership and the ability of the health coaches to create material based on behavior insights and the work culture of the participants, Deborah A. Greenwood, PhD, RN, BC-ADM, CDCES, FADCES, adjunct assistant professor at UT Health San Antonia School of Nursing, said in the presentation.
“It's not one size fits all in diabetes education,” Greenwood, who is an Endocrine Today Editorial Board Member, told Healio. “The benefit of this program is that it is individualized with the behavior diagnostic, so you can see the challenges, and ... then the coach can tailor the lessons.”
Reference:
- Ely EK, et al. Diabetes Care. 2017;doi:10.2337/dc16-2099.
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Greenwood D and Welch G. 12-Month Outcomes for a Behaviorally Enriched Diabetes Prevention Program for State Employee Commercial Drivers. Presented at: Association of Diabetes Care & Education Specialists Annual Meeting; Aug. 13 - 16, 2020; (virtual meeting).
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