Technology to Scale a Phone-Based Diabetes Prevention Program

Inquisithealth, Inc., Hackensack NJ

Investigators

Abstract

? DESCRIPTION (provided by applicant): The Specific Aim of this SBIR Phase I proposal is to test the feasibility of using a technology platform to scale a newly validated method of telephonic delivery of the Diabetes Prevention Program (DPP) for African American and Hispanic patients who do not use the internet (17-20%, Pew 2014). About 70% of the 80 million people with pre-diabetes will acquire diabetes over their lifetime. This risk of diabetes is in our target populatins if over 66 -77% higher compared to non-Hispanic white Americans. Lifestyle change is the most efficacious intervention to prevent progression from pre-diabetes to diabetes. DPP is a proven intensive lifestyle intervention that significantly reduces the risk of developing diabetes by 58%, compared to 31% receiving the first line diabetes medication. Cost limitations have prevented wide dissemination of the DPP, which was originally delivered in-person, 1-on-1, and by health professionals. To address this hurdle, DPP was delivered by trained lay individuals using in-person groups. While effective, the in-person use still imposes time, convenience and cost constraints. To address some of these barriers to widespread dissemination, internet- based DPP programs were developed. However, about 20% of African Americans and 17% Hispanics do not use the Internet. Within this group, the internet is not used by >41% of senior citizens, >44% of adults with less than a high school education, and >25% of those in households with income < $30,000. Notably, these populations all have a disproportionate prevalence of diabetes and are thus most likely to benefit. As a solution, our team used manual methods to successfully adapt the DPP for telephonic delivery, since 98% of households have either a wireless or landline telephone service. This five year NIH funded study showed that delivery of the DPP is highly effective, yet has key limitations that prevent widespread dissemination. First, coaches need to be trained to deliver the DPP telephonically. There is an existing network of 1200+ CDC- approved coaches trained to deliver DPP in-person. Since these coaches are distributed nationally, training them in-person for telephonic delivery of DPP will be cost-prohibitive and not practical. To address this weakness, we will develop a web-based training program for these coaches (Task 1). Second, managing a geographically distributed network of coaches, enrolling patients into telephonic classes, and managing/tracking classes will also be difficult. To address this issue, we will develop a common web-based technology platform to help manage and support coaches and administrators (Task 2). In Task 3, we will carry out a pilot study to test the feasibility of using this web-based approach to allowing widespread dissemination of telephonic delivery of the DPP. In Phase II, we will improve our product, as informed by the results of Phase I and then conduct a randomized clinical trial involving the delivery of the full DPP. We expect to develop and disseminate an evidence-based, scalable, easy-to-implement intervention that can be utilized to prevent diabetes in underserved communities.