T2D self-management education and support (DSMES) provides patients with critical information and problem-solving skills to self-manage their disease. It can improve medication adherence, self-blood glucose monitoring, glycemic control, and dietary behaviors, as well as reduce complications from uncontrolled diabetes. “While DSMES has been shown to have numerous benefits, it can be challenging to find time to implement it during primary care visits,” says Roy T. Sabo, PhD. Many patients with T2D do not receive DSMES. Factors like time commitment, schedule conflicts, or transportation difficulties have been identified as barriers to DSMES. As such, innovative DSMES delivery methods are needed to better meet patients’ needs.

The Diabetes Engagement and Activation Platform

For a study published in JMIR Diabetes, Dr. Sabo and colleagues evaluated the feasibility and effectiveness of the Diabetes Engagement and Activation Platform (DEAP), an automated patient educational tool. The DEAP is integrated directly into the primary care workflow and is accessed from a patient portal. It consists of nine modules that address guideline-recommended domains of diabetes education. The DEAP assesses patients’ knowledge and confidence in managing each domain and alerts care team members on what patients may need.

“The DEAP was designed as a way to offload the DSMES into the online platform,” Dr. Sabo says. “This enables use of freely and publicly available resources that can help patients better manage their disease. It focuses on all relevant, nationally determined standards, such as nutrition, physical activity, and blood glucose monitoring.”

Improvements With DEAP

In the study, 337 adult patients with a A1C levels of at least 8% were offered an invitation to DEAP or usual care, with the latter receiving no invitation to DEAP. Participants invited to DEAP and who completed the modules had high knowledge and confidence scores. Intervention patients had lower BMIs than control patients at 3 and 6 months, and improvements were even greater for those who completed at least one DEAP module (Table). Although there were no differences in 3- or 6-month A1C or blood pressure levels in an intent-to-treat analysis, intervention patients completing at least one DEAP module had better A1C levels at 3 months.

“Since our study had a relatively short duration, we weren’t sure if our intervention would lead to meaningful improvements in health outcomes,” says Dr. Sabo. “We were pleasantly surprised to see BMI decreases over 3 and 6 months in patients receiving invitations to access DEAP. This difference was slightly greater when we excluded those who received invitations to access DEAP but never completed any of the DEAP modules. Our findings must be confirmed in a larger trial with other settings, but they’re exciting results nonetheless.”

Fostering Conversations

DEAP may give hope to primary care physicians (PCPs) who manage patients with uncontrolled T2D, according to Dr. Sabo. “PCPs may feel limited in what they can accomplish in a 15-minute office visit,” he notes. “Although patient use of DEAP can’t replace live discussions with their PCPs, our intervention might serve as a starting point to foster conversations with patients about their diabetes care. DEAP gives patients a structured and organized format to encourage them to learn on their own. This can empower patients to have more constructive and informative dialogue with PCPs about managing their diabetes.”

More to Come

According to Dr. Sabo, optimizing the implementation of DEAP into clinical practice is an important area of future research. “Ideally, we’d like to share information with diabetes care team members about how patients are progressing through the DEAP curriculum,” he says. “With this functionality, DEAP could prime patients to speak to their diabetes care team while simultaneously alerting team members about areas for which more patient education is required. In addition, relatively simple improvements—such as embedding questions into videos or chats and periodically monitoring questions and responses—could go a long way to improving the effectiveness of DEAP.”

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