@Article{info:doi/10.2196/jmir.4052,
author="Sepah, S Cameron
and Jiang, Luohua
and Peters, Anne L",
title="Long-Term Outcomes of a Web-Based Diabetes Prevention Program: 2-Year Results of a Single-Arm Longitudinal Study",
journal="J Med Internet Res",
year="2015",
month="Apr",
day="10",
volume="17",
number="4",
pages="e92",
keywords="prediabetes; type 2 diabetes; obesity; diabetes prevention program; internet; online; mobile apps; mhealth; digital health; intervention",
abstract="Background: Digital therapeutics are evidence-based behavioral treatments delivered online that can increase accessibility and effectiveness of health care. However, few studies have examined long-term clinical outcomes of digital therapeutics. Objective: The objective of this study was to conduct a 2-year follow-up on participants in the Internet-based Prevent diabetes prevention program pilot study, specifically examining the effects on body weight and A1c, which are risk factors for diabetes development. Methods: A quasi-experimental research design was used, including a single-arm pre- and post-intervention assessment of outcomes. Participants underwent a 16-week weight loss intervention and an ongoing weight maintenance intervention. As part of the program, participants received a wireless scale, which was used to collect body weight data on an ongoing basis. Participants also received A1c test kits at baseline, 0.5 year, 1 year, and 2-year time points. Results: Participants previously diagnosed with prediabetes (n=220) were originally enrolled in the pilot study. A subset of participants (n=187) met Centers for Disease Control and Prevention (CDC) criteria for starting the program (starters), and a further subset (n=155) met CDC criteria for completing the program (completers) and were both included in analyses. Program starters lost an average of 4.7{\%} (SD 0.4) of baseline body weight after 1 year and 4.2{\%} (SD 0.8) after 2 years, and reduced A1c by mean 0.38{\%} (SD 0.07) after 1 year and 0.43{\%} (SD 0.08) after 2 years. Program completers lost mean 4.9{\%} (SD 0.5) of baseline body weight after 1 year and 4.3{\%} (SD 0.8) after 2 years, and reduced A1c by 0.40{\%} (SD 0.07) after 1 year and 0.46{\%} (SD 0.08) after 2 years. For both groups, neither 2-year weight loss nor A1c results were significantly different from 1-year results. Conclusions: Users of the Prevent program experienced significant reductions in body weight and A1c that are maintained after 2 years. Contrary to the expected progression from prediabetes to diabetes over time, average A1c levels continued to show an average regression from within the prediabetic range (5.7{\%}-6.4{\%}) initially to the normal range (<5.7{\%}) after 2 years. Further investigation is warranted to test digital therapeutics as a scalable solution to address national diabetes and cardiovascular disease prevention efforts. ",
issn="1438-8871",
doi="10.2196/jmir.4052",
url="http://www.jmir.org/2015/4/e92/",
url="https://doi.org/10.2196/jmir.4052",
url="http://www.ncbi.nlm.nih.gov/pubmed/25863515"
}