Examining a Remote Group-Based Type 2 Diabetes Self-Management Education Program in the COVID-19 Era Using the ORBIT Model: Small 6-Week Feasibility Study.

Publication date: Jan 29, 2024

To date, most group-based diabetes self-management education (DSME) programs for type 2 diabetes (T2D) have been delivered in person. The rapid transition to remote care at the outset of the COVID-19 pandemic presented opportunities to test, evaluate, and iterate a new remote DSME program. We aim to refine the delivery and evaluation of a multicomponent remote DSME program for adults living with T2D by examining several feasibility outcomes. We recruited a convenience sample of patients from a London, Canada, outpatient diabetes clinic (serving high-risk, low-income adults) to participate in a 6-week, single cohort feasibility study from November 2020 to March 2021. This small ORBIT phase 1b feasibility study represents the first in a planned series guided by the ORBIT model for developing behavioral interventions for chronic diseases (phase 1: design; phase 2: preliminary testing; phase 3: efficacy; and phase 4: effectiveness). The feasibility of delivering and evaluating a remote DSME program, including (1) live video education classes, (2) individualized physical activity (PA) prescription and counseling, and (3) intermittently scanned continuous glucose and wearable PA monitoring, was assessed. Feasibility outcomes included recruitment and retention rates, program adherence, and acceptability (ie, technology issues and exit survey feedback). PA was assessed with Fitbit Inspire 2 (Fitbit Inc) and estimated glycated hemoglobin (HbA) using the FreeStyle Libre (Abbot). Given the small study sample, group- and individual-level data are reported descriptively. A total of 10 adults living with T2D were recruited (female 60%; age 49. 9, SD 14. 3 years; estimated HbA 6. 2%, SD 0. 5%). Recruitment and retention rates were 29% and 80%, respectively. Participants attended 83% (25/30) and 93% (37/40) of education classes and PA counseling phone calls, respectively. There were 3. 2 (SD 2. 6) technology issues reported per person, most of which were related to study data transfer. Exit survey responses suggest most participants (8/9, 89%) were “satisfied” with the program. Recognizing the small sample size and the fact that no inferential statistics were conducted, the mean (SD) for the weekly daily step count and estimated HbA are provided for illustrative purposes. Participants accumulated 7103 (SD 2900) and 7515 (SD 3169) steps per day at baseline and week 6, respectively. The estimated HbA was 6. 2% (SD 0. 5%) and 6. 2% (SD 0. 6%) at baseline and week 6, respectively. This ORBIT phase 1b study served to refine the delivery (eg, automatic study data upload process recommended to reduce participant burden) and evaluation (eg, purposeful sampling of participants with baseline HbA >8% recommended to address selection bias) of a remote DSME program. Preliminary proof-of-concept testing (ORBIT phase 2) incorporating some of these learnings is now warranted. ClinicalTrials. gov NCT04498819; https://clinicaltrials. gov/study/NCT04498819.

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Concepts Keywords
Canada activity monitor
Clinicaltrials diabetes self-management education
Diabetes flash glucose monitor
Freestyle glycated hemoglobin
Weekly group education
type 2 diabetes
virtual care


Type Source Name
disease MESH Type 2 Diabetes
disease MESH COVID-19
disease VO Canada
disease MESH chronic diseases
disease VO effectiveness
drug DRUGBANK Dextrose unspecified form
disease IDO process
disease VO effective
disease MESH complications
disease VO efficiency
drug DRUGBANK Methyltestosterone
disease IDO intervention
disease VO biweekly
disease VO time
disease VO device
disease IDO blood
disease MESH education level
disease VO protocol
disease VO Optaflu
disease VO population
drug DRUGBANK Etoperidone
disease VO monthly
disease VO frequency
drug DRUGBANK Dimethyl sulfone
disease IDO site
disease IDO history
drug DRUGBANK Coenzyme M
disease MESH lifestyle
disease VO Pal
disease MESH overweight
disease MESH diabetes mellitus
disease MESH cystic fibrosis
disease MESH COPD

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