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Study of Diabetes Self-Management Program Finds Parity Between In-Person, Digital Formats

Mary Caffrey
A diverse group of 1242 patients received diabetes self-management education either in-person or online and achieved lowered blood glucose and depression levels, had fewer symptoms of hypoglycemia, and exercised more.
A national study of Stanford University’s diabetes self-management education (DSME) program involving 1242 patients has found that the digital format was just as effective as in-person lessons in lowering blood sugar and reducing depression when given in real-world environment.

The study, published in the Journal of Medical Internet Research, examined the effectiveness of the Better Choice, Better Health diabetes program, which was developed at Stanford and is now offered in both in-person and digital formats to health plans. In this study, the program was offered to patients recruited through Anthem, according to a statement from Canary Health, which provides digital self-management education for several chronic conditions.

DSME is recognized as an effective way to give patients with diabetes the tools to manage their disease, preventing progression and complications. A joint statement from the American Diabetes Association, the American Association of Diabetes Educators (AADE), and the Academy of Nutrition and Dietetics in 2015 found the numbers of patients who get training “disappointingly small,” and the organizations developed an algorithm to extend DSME more patients with type 2 diabetes (T2D), especially those newly diagnosed.

The new study cites similar concerns, and says that less than 7% of those with T2D receive DSME in the year after diagnosis. While the AADE has standards, few Stanford model programs meet the national standards for diabetes self-management education and support, say the authors, led by Kate Lorig, DrPH, a pioneer in self-management education and the director of the Stanford Patient Education Research Center.

At present, the authors write, there is “no means for certifying or recognizing web-based programs,” in DSME. This is not the case in diabetes prevention; the CDC has recognized digital as well as face-to-face programs, and CMS expects to include digital formats when Medicare begins paying for diabetes prevention programs in 2018.

Lorig’s Stanford model, which involves 6 weeks of training and can include a family member, is centered on the personalized “action plan,” a detailed outline of how the person with T2D will achieve desired amounts of exercise or stick with dietary goals. In the Better Choices, Better Health digital format, groups of roughly 25 people form online discussion groups where they are supported by coaches, who are peers with a chronic condition themselves. Community-based programs have reached more than 50,000 people in 39 states, the authors report, and web-based programs have reached 2000.
With 29 million people in the United States living with diabetes—most of them T2D—the potential to reach many more people at a lower cost makes digital formats attractive, assuming they are shown to be effective.

Results in the new study suggest they are.

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