Introduction: Online Diabetes Prevention Programs (DPPs) can be scaled up and delivered broadly. However, little is known about real-world effectiveness and how outcomes compare with in-person DPP. This study examined online DPP weight loss and participation outcomes and secondarily compared outcomes among participating individuals with parallel in-person interventions. Study design: A large non-randomized trial supplemented by a comparative analysis of participating individuals from a concurrent trial of two parallel in-person programs: in-person DPP and the Veterans Administration's standard of care weight loss program (MOVE!). Setting/participants: Obese/overweight Veterans with prediabetes enrolled in online DPP (n = 268) between 2013 and 2014. Similar eligibility criteria were used to enroll in-person participants between 2012 and 2014 (n = 273 in-person DPP, n = 114 MOVE!) within a separate trial. Intervention: Online DPP included a virtual group format, live e-coach, weekly modules delivered asynchronously, and wireless home scales. In-person programs included eight to 22 group-based, face-to-face sessions. Main outcomes measures: Weight change at 6 and 12 months using wirelessly uploaded home scale data or electronic medical record weights from clinical in-person visits. Outcomes were analyzed between 2015 and 2017. Results: From 1,182 invitations, 268 (23%) participants enrolled in online DPP. Among these, 158 (56%) completed eight or more modules; mean weight change was –4.7 kg at 6 months and –4.0 kg at 12 months. In a supplemental analysis of participants completing one or more sessions/modules, online DPP participants were most likely to complete eight or more sessions/modules (87% online DPP vs 59% in-person DPP vs 55% MOVE!, p < 0.001). Online and in-person DPP participants lost significantly more weight than MOVE! participants at 6 and 12 months; there was no significant difference in weight change between online and in-person DPP. Conclusions: An intensive, multifaceted online DPP intervention had higher participation but similar weight loss compared to in-person DPP. An intensive, multifaceted online DPP intervention may be as effective as in-person DPP and help expand reach to those at risk.
Bibliographical noteFunding Information:
This work was funded by the VA (QUERI SDP-13-230, SDP 12-549 and NCP XVA 41-048). TM received support from VA QUERI (QUE 15-272) and Centers for Disease Control and Prevention/National Institute of Diabetes and Digestive and Kidney Diseases (U18DP006128) and NIH/National Institute of Diabetes and Digestive and Kidney Diseases (1R18DK105464-01) and the VA Office of Academic Affiliations through the VA Health Services Research and Development Advanced Fellowship Program (TPM65-010, 2011–2014). MAY received support through the VA Health Services Research and Development Advanced Postdoctoral Fellowship Program, VA Ann Arbor. MLM reported receiving support from the VA (RCS 10-391).