December 18, 2019

Telehealth grant boosts diabetes prevention efforts

Vanderbilt’s Diabetes Prevention Program (DPP) has demonstrated its effectiveness at helping employees lose weight as a means of preventing Type 2 diabetes and has received a five-year grant from the National Institutes of Health (NIH) to expand the program using telehealth.

Lisa Connor, RN, left, Rosette Chakkalakal, MD, MSH, and colleagues in Vanderbilt’s Diabetes Prevention Program are helping employees lose weight as a means to prevent Type 2 diabetes. (photo by Susan Urmy)

Vanderbilt’s Diabetes Prevention Program (DPP) has demonstrated its effectiveness at helping employees lose weight as a means of preventing Type 2 diabetes and has received a five-year grant from the National Institutes of Health (NIH) to expand the program using telehealth.

The National Diabetes Prevention Program is an initiative of the Centers for Disease Control and Prevention (CDC). Vanderbilt’s DPP is a no-cost wellness benefit available through Health Plus for eligible VU and VUMC employees and spouses. Vanderbilt is one of about 100 employers nationwide that offers access to the National DPP as an employee benefit.

Vanderbilt Health & Wellness recently published research in the CDC journal Preventing Chronic Disease that, among other findings, showed that Vanderbilt’s DPP is more effective than other National DPP providers at helping its participants achieve the program’s 5% weight loss goal. Among Vanderbilt DPP participants, 43.6% met this goal compared to 35.5% of DPP participants nationwide.

“We wanted to take a look at what was working and what was driving participants’ success,” said Rosette Chakkalakal, MD, MHS, assistant professor of Medicine and medical director of Health Plus, the Vanderbilt faculty/staff health promotion and prevention program.

The key finding of the research into the success of Vanderbilt’s program, published under the title “Putting the National Diabetes Prevention Program to Work: Predictors of Achieving Weight-Loss Goals in an Employee Population,” showed that the dedication of participants was a major factor in their success. Session attendance and physical activity outside of class independently predicted achievement of the 5% weight-loss goal.

“We already knew participation was important, but the results showed it,” said Lisa Connor, RN, program coordinator for the DPP, assistant manager of Health Plus and a certified health coach. “What you put in predicts what you get out.”

Vanderbilt’s DPP was established in 2014 by Mary Yarbrough, MD, MPH, executive director of Vanderbilt Health and Wellness, and Lori Rolando, MD, MPH, director of the Occupational Health Clinic. Since Health Plus began offering the DPP, approximately 250 employees and spouses have completed the program, in which groups of participants attend regular meetings for education, skill building and support.

“It’s a commitment,” Connor said. “You commit to a year. It’s a lifestyle change.”

Vanderbilt has five staff members trained as DPP lifestyle coaches.

These coaches work directly with participants via 16 weekly sessions for the first six months, six biweekly sessions for the next three months, then monthly sessions for the final three months of the program year.

“Our study found that our participants really stick with it,” Chakkalakal said.

Because the program requires a significant commitment of time to attend group sessions, especially in its first six months, some people who could benefit have been unable to participate.

“We could see the program was working, but we wanted to make it more accessible,” Chakkalakal said. “Participant feedback told us that group structure was really important.”

To make the group sessions more accessible to employees, Vanderbilt’s DPP partnered with VUMC’s telemedicine program in 2018 to offer a “distance learning” participation option in addition to the existing “in-person” participation option. Participants can log in via a computer, smartphone or tablet and be part of a virtual group, all of whom are “meeting” at the same time. This “real-time” aspect allows some of the cohesive group dynamic to take place even when people are attending remotely.

“We can all see each other even though we’re in different places,” Connor said.

The Vanderbilt DPP has 65 current participants — 27 who attend the meetings in person and 38 who use the distance-learning option.

The distance-learning option received full recognition from the CDC earlier this year, a “stamp of approval” that the in-person program has had since 2017.

Chakkalakal recently received a five-year R01 grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the NIH to continue to develop and evaluate the effectiveness of using telehealth to deliver the distance-learning option of the DPP.

The findings of the study have the potential to inform how the CDC implements the national DPP and the way Medicare reimburses DPP providers nationally.

In addition to Chakkalakal and Connor, Vanderbilt collaborators included Rolando and Yarbrough; Yi Huang, MS; Daniel Byrne, MS; Bradley Awalt, MS; Paula McGown, RN, CPA; and Muktar Aliyu, MD, DrPH.

The study was supported by NIH grant P30DK092986. The study also received funding from a contract with the CDC and the Tennessee Department of Health Services (VUMC54498 [34352-26918]). Data management involved the use of Research Electronic Data Capture (REDCap, UL1TR000445, National Center for Advancing Translational Sciences/National Institutes of Health).