Accepted for/Published in: JMIR Diabetes
Date Submitted: Dec 18, 2020
Open Peer Review Period: Dec 18, 2020 - Feb 12, 2021
Date Accepted: Feb 28, 2021
(closed for review but you can still tweet)
Implementation and effectiveness from a randomized controlled trial of automated virtual type 2 diabetes self-management education: Diabetes Engagement and Activation Platform
ABSTRACT
Aims: To help patients with type 2 diabetes receive recommended self-management education and support (DSMES), we designed the Diabetes Engagement and Activation Platform (DEAP) – an automated patient education tool integrated into primary care workflow – and examined its implementation and effectiveness.
Methods:
We invited patients age 18-85 years with hemoglobin A1C (HbA1c) ≥ 8 to participate in a randomized controlled trial comparing DEAP to usual care. DEAP modules addressing DSMES 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, body mass index (BMI), and blood pressure were measured.
Results:
Implementation: Out of the 680 patients invited to participate 337 (49%) agreed and were randomized. Of 189 intervention patients, all accessed the first module and 140 (74%) accessed all nine modules. Post-module knowledge and confidence scores were high. Only 18 patients requested additional help from the care team. Effectiveness: BMI was lower for intervention patients than controls at 3 months (31.7 versus 32.1 km/m2, p=.04) and 6 months (32.5 versus 33.0 km/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 in the intention to treat analysis. However, intervention patients completing at least one module compared to controls had a better HbA1c (7.6% versus 8.2%, p=.03) and DBP (72.3 versus 75.9 mmHg, p-value = .01) at 3 months.
Conclusions:
A significant proportion of patients will participate in an automated virtual diabetes self-management program embedded into patient portals and system show promise in helping patients manage their diabetes, weight, and blood pressure.
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