Diabetes Support Group Report 2022

Context

This new patient support group was developed by the Digital Team at Frome Medical Practice (with clinical input from Dr Nick Hopkins, GP Diabetes Lead and from Joanne Fordham, Health Coach). It is a clinical improvement pilot programme to explore the impact of education about Type 2 Diabetes (T2D) and the beneficial effects of healthy lifestyle, combined with wearable health technology, on patients' ability to self-manage their condition.

We provided free wearable health monitoring technology (Fitbits - linked to the MyWay Diabetes’ [MWD] online platform) to encourage patients to understand, monitor, and set goals to reduce their diabetes risk factors.  

The group ran at the practice from Aug-Nov 2022 and was initially aimed at newly-diagnosed diabetics.  

Aims 

To prove that the combination of themed healthy lifestyle patient education, wearable health technology, and preventative apps – used alongside the MWD portal - gives patients greater awareness of - and confidence in - their ability to self-manage their condition and improve their general health and wellbeing. 

Programme Outline 

The programme delivered five face-to-face sessions, one every two weeks.

Pre- and Post- surveys measuring patients’ understanding tracked changes in patient knowledge of the three key themes of healthy living explored in the sessions: activity, diet, relaxation and sleep. We also took a pre- and post- wellbeing score at the start and end of the programme. 

Patients also signed an expectations and responsibilities document to outline responsibilities on both sides and underline the importance of engagement. It also included permissions for data sharing, remote monitoring, and consent.

1. Onboarding session (Fitbit and MWD masterclass): showed patients how to use the Fitbit/Fitbit App, and the MWD portal to monitor and understand how their health data can be viewed, set, recorded, and reviewed by the combination of wearable health technology and apps. 
2. Three sessions on the key healthy lifestyle themes. Sessions featured a mixture of educational segments (including videos), live practical demonstrations, and exercises/practices promoting healthy behaviours, and facilitated goal setting around small, incremental behaviour changes in each session. We tailored our education on manageable behaviour change around the Fitbit’s functionality, using BJ Fogg’s idea of ‘Tiny Habits’. Resources and preventative apps were prescribed to reinforce self-management around the key themes in between the formal sessions.
3. Final session – collection of survey’s for final post programme results, and encouragement to continue healthy lifestyle behaviour change (external speaker on subsidised local activity schemes e.g.GP exercise referral etc).
4. We were also able to recruit voluntary external community speakers (Nordic Walking, Mindfulness Coach, gym, Pilates, yoga classes) to construct a varied and engaging programme.

Patient Recruitment

The group ran with 15 patients selected from a pool of T2D diagnosed in the last 8 months. All patients were supplied with free Fitbits and registered with a MWD account - allowing data to be shared between Fitbit & MWD. All patients were clinically approved by the practice GP Diabetes Lead, and patients were warned about red flags of increased exercise and dietary change. They were also informed when (and how) to seek relevant medical attention. 

Any patients already enrolled onto an existing diabetes program were also excluded. 

All patients continued to attend their regular review appointments as usual; the programme was an add-on to their ongoing clinical care.

Patient engagement was very high measured in terms of attendance for all sessions and qualitative feedback. All 15 patients finished the programme and submitted results.

Results

Results were drawn from three sets of data (clinical indicators, learning outcomes, wellbeing survey), measured pre/post (August and Nov/Dec - three months after first support session).

Overall, 100% of patients improved in two or more areas, although some changes were smaller than others.

Below we give:

1. The overall percentage of the group that improved in the three key T2D clinical indicators: HbA1c/BMI/BP.
2. The overall percentage of the group that improved their understanding of the three key themes of healthy living explored in the sessions: activity, diet, and relaxation and sleep).
3. The overall percentage of the group that improved their emotional needs and resources scores in our Wellbeing Survey.

Clinical Indicators: Overall, 80% of the group made improvements in one or more clinical indicators.

HbA1c = 60%

BMI = 40% improved their body mass index score.

BP = 40% improved their blood pressure.

Learning Outcomes/Understanding = 100% of the group improved their understanding of diabetes.

Wellbeing = 73% of the group improved in their social and wellbeing factors.

Case Studies

Patient success stories: a deeper dive into specific patients that have made significant changes. All these cases studies made three or more improvements in key areas. Below we show in which areas positive changes have been made.

Patient A (male, 64)

• BP down from 156/57 - 126/82
• HbA1c down from 94-42. This patient has achieved pre-Diabetes level.
• Learning Outcomes (How to manage your T2D) up from 9-17
• Step Count (average weekly) consistently above or just below daily goal of 10k from Aug to Dec

Patient B (female, 51)

• BP down from 143/93 - 140/79
• HbA1c down from 54-50
• Learning Outcomes 16-17

Patient C (female, 73)

• Blood Pressure down from 157/90- 147/83
• HbA1c down from 47-46
• Learning Outcomes up from 13-16
• BMI down from 27.88 to 27.4

Patient D (male, 58)

• BP down 133/82 – 131/71
• HbA1c 50-40
• BMI 26-25
• Learning Outcomes

Patient E (male, 35) 

• Learning Outcomes up from 12-18
• Wellbeing up from 48-65
• BMI down from 31-29

Patient F (female, 43)

• HbA1c – 50-46
• Learning Outcomes up from 15-18
• BMI down from 35-34

 

Conclusion

Key Points

1. We showed that the integration of Fitbits, structured healthy lifestyle education, and preventative apps encourages meaningful beneficial patient changes.
2. Fitbits were our key tool to facilitate and embed manageable behaviour change and encourage a culture of self-management.
3. The MyWay Diabetes portal gave the patients a central location where they can see their whole diabetes journey. This combines their Fitbit data with their medical key risk indicators, as well as allowing them to further explore structured education.

The Fitbit gives visibility of selected health data creating a level of patient ownership of their own health which encourages the development of a culture of self-management.

But first, patients must be given a basic understanding of how the Fitbit works – its features and functionality. Only then can patients understand how best to use them to be healthier. *

In addition, Fitbit must be embedded in a shared context of healthy lifestyle education to become a true virtual health coach encouraging meaningful - but manageable - healthy behaviour change.

In this pilot project, the Fitbits were integrated into - and synchronised - with the content of our healthy lifestyle sessions. We tailored our education on manageable behaviour change around the Fitbit’s functionality, using BJ Fogg’s idea of ‘Tiny Habits’. 

Further integration of the Fitbit with MWD encouraged patients to use this clinically assured online portal for all their T2D information. Here they could see both their health record data and Fitbit data combined with online structured education modules giving step-by-step advice to further explore the links between healthy lifestyles and reduced diabetes risk.

In conclusion, this project shows that a mixed model approach in combining patient education with digital health technology, is a sustainable approach in primary care reducing clinical demand and embedding a resilient culture of self-management.

Rachel Haupt, Team Lead- Digital, Data and Technology and Andrew Hull Training and Development Coordinator, at Frome Medical Practice. February 2023.