Currently submitted to: JMIR Diabetes
Date Submitted: Jun 26, 2019
Open Peer Review Period: Jul 2, 2019 - Aug 27, 2019
(currently open for review)
Exploring the impact of a digital technology for facilitating lifestyle change in obese and type 2 diabetes populations; a service evaluation of real-world data
The prevalence of type 2 diabetes and obesity is increasing, and the way people interact with healthcare is evolving. Services aimed at supporting people to improve their nutrition, physical activity or learn more about the self-management of type 2 diabetes have traditionally been delivered in a face-to-face setting. These services have a strong evidence base, but they have limitations for reaching certain groups of people. The development of digital interventions could provide a new model, helping people to access health-education and behaviour change support, but long-term data supporting these programmes is limited.
The purpose of this service evaluation was to analyse the efficacy of OurPath, a UK-based digital lifestyle change programme that combines a private online social network, daily structured educational content, health coaching, digital weighing scales, and an activity tracker, in people living with obesity and type 2 diabetes.
Participants had a mean (±SD) age of 50±11.5, BMI 34±6.3kg/m2, were 20% male and either self-referred (commercial – self paid) or referred by a GP (NHS – free to the user) to the digital behaviour change programme. Participants underwent a core 3-month intensive lifestyle change intervention, with additional follow up support provided to help people to maintain health changes. HbA1c change after 6-months and weight change after 3, 6, 9, 12-months were primary outcome measures. Changes in weight after 24-months and differences in weight loss between participant demographics were further analysed as secondary outcome measures.
Participants had a mean (±SD) starting BMI of 34±6.3kg/m2. Those with available data had a mean baseline HbA1c level of 66.2±20.5mmol/mol. Data from 1820 participants at 6-months showed a change in mean weight of -6.6kg (-6.9±6.92%; P<0.01). Data from 705 participants at 12-months showed a sustained change in mean weight when compared to baseline of -5.7kg (-5.9±5.9%; P<0.01). For 105 participants with available data at 24-months, the average sustained weight change was -5.5kg (-5.9±6.0%; p<0.01). This weight change was significant for both 63 commercial participants (mean -4.5kg; -5.0±8.9%; P<0.01) and 42 NHS participants (mean -5.7kg; -6.2±8.8%; P<0.01). 47% of these participants achieved >5% weight loss and 24% achieved >10% weight loss. The proportion of males that took part in the programme following NHS referral was 43%, compared with 10% in commercial programme.
This service evaluation demonstrates significant sustained weight loss can be achieved for participants. A higher male uptake ratio was also achieved when referred by an NHS HCP. With ongoing challenges of uptake and attendance at traditional weight-loss programmes, a digitally delivered intervention may offer a more convenient solution for some people.
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