Diabetes remains one of the top health challenges for the US. According to the American Diabetes Association, approximately 9% of the country has some form of diabetes with prevalence rates as high as 15% in some communities and costs of nearly $250 billion each year. Numerous efforts are ongoing to address this challenge. A recent article in the Journal of Medical Internet Research highlights a successful randomized controlled trial that used an online intervention to address the problem of diabetes in overweight adults.
Researchers recruited study participants nationally with online ads on different websites, including Facebook and Craigslist, as well as radio and newspaper ads. Participants selected for the study were over 18 years old, had a body mass index equal to or greater than 25, elevated HbA1c level diagnostic of type 2 diabetes, taking no medications other than Metformin, and Internet access. The researchers also assessed readiness to change in order to eliminate participant drop out once the intervention started. After the intervention began, outcomes were assessed at 16 and 32 weeks and researchers were paid $25 for each assessment. A few hundred people signed up for the study but most were eliminated because they didn’t have type II diabets or they were taking medications other than Metformin. The final number of participants was 25, intervention (n=12) and control (n=13).
The online intervention treatment group received weekly emails for 16 weeks and biweekly emails for the following 16 weeks during the 32 week intervention. The control group received weekly emails the first four weeks and emails every 4 weeks throughout the study. The treatment group received emails with recommendations on how to eat a low carbohydrate ketogenic diet, lifestyle/behavioral recommendations, and lessons on increasing physical activity and sleep. The control group received emails on the plate method as their dietary guidance but no lifestyle/behavioral recommendations. The primary outcome measure for the study was glycemic control assessed by examining change in HbA1c level and a secondary outcome was body weight.
The results demonstrated that the intervention led to weight loss and lower HbA1c levels. There was a statistically significant decrease in HbA1c levels at 32 weeks in more than half of the people in the intervention group to less than 6.5%, compared to no change in the control group (p = .02). There was also a statistically significant decrease in the body weight for the intervention group, with 90% of the group losing weight compared to the control group (p = .01). There was also a statistically significant drop in tryglyceride levels. Most of the intervention group stayed in the study but over half of the control group dropped out. The researchers concluded that the online delivery of dietary and lifestyle recommendations may allow them to reach a larger audience to help people self-manage Type II Diabetes.
This smaller study offers potential promise for interventions of this type, but the study needs to be replicated in a larger group independently before the results are generalizable. There may also be concerns with selection bias given the substantial drop in the number who signed up versus the number who were selected and participated in the study. The intervention also provides a useful approach for any businesses looking to lower the number of employees who have Type II Diabetes. In fact a business might be the best target for expanding future clinical trials using this intervention.