A Silicon Valley start-up launched an online diabetes prevention program yesterday, of the sort that has data to support its efficacy and cost-effectiveness.
When Tracy Jordan, a character on the television show 30 Rock, gets diagnosed with prediabetes, he isn't too concerned. "How bad is diabetes, really?" he asks his doctor.
Told he might lose a foot, Tracy seems more resigned than alarmed. "Could I replace it with a wheel?" he wants to know. ("I suppose," the doctor replies; "But then you'd have to register as a motor vehicle.")
Wheels aside, diabetes isn't a laughing matter. The 26 million Americans who have it are at increased risk of heart attacks, strokes, kidney failure, and more.
Equally alarming are the 79 million Americans with prediabetes (including, at one point, 30 Rock actor Alec Baldwin). Prediabetics reliably go on to develop clinical diabetes; at the current rate, one in three Americans will have diabetes by 2050.
But what Tracy and many others may not realize is that diabetes is preventable -- through modest weight loss, it's possible to step back from the brink of disease. This suggests a unique opportunity for intervention. A solution that helps prediabetics make a few key lifestyle changes could save literally millions of lives -- not to mention billions of dollars.
Fortunately, such a solution may already exist.
The Diabetes Prevention Program, a landmark clinical research study led by the National Institutes of Health (NIH) and supported by the Centers for Disease Control and Prevention (CDC), demonstrated that intensive coaching in behavior modification reduces the risk of progression from prediabetes to diabetes by nearly 60 percent. Even more remarkably, 10 years after the trial ended, the benefits of the intervention persisted.
"What drives behavior change is relationships."
Similar diabetes prevention programs (DPPs) have since been established across the country; most are based out of community centers like YMCAs. Their strategy is to use social support mechanisms -- group meetings and sessions with health coaches -- to help prediabetics achieve lasting changes in behavior.
Martha Funnell of the Michigan Diabetes Research and Training Center explains why this approach is unique: "Weight loss or exercise programs just emphasize one element or another; they don't tell you how to fit the pieces together. It's hard to continue with them because, as my patients say, 'Life happens.' DPPs help people figure out how to incorporate exercise and healthy eating into their existing lives and make changes that will stay with them for a lifetime."
But the current DPP model is far from perfect. Access is a major issue: most states have only a few CDC-recognized facilities, and eighteen states -- including Alabama and Mississippi, which carry some of the nation's highest rates of diabetes and obesity -- have no facilities at all.
Sean Duffy, co-founder of the Silicon Valley start-up and IDEO spinoff Omada Health, saw an opportunity to deliver the benefits of DPPs to a broader audience. If most prediabetics weren't going to a DPP in person, why not bring a DPP to them?
Such was the impetus for Duffy and his co-founder Adrian James to create an online DPP called Prevent. The program, which officially launched this week, is the first of its kind. Prevent matches prediabetics into small online groups based on age, body mass index, and location. Participants are mailed a wireless scale; every day, the scale transmits their weight to the online system. Participants can monitor not only their own progress, but also that of fellow group members (shown as percentage of body weight lost).