Improving self-management of type 2 diabetes is a strategic priority for the NHS due to the increased number of people diagnosed with type 2 diabetes and the impact of devastating and costly complications that can be prevented. Good diabetes management and improving lifestyle factors such as weight and activity levels can reduce the risk of complications. However, while structured education courses can help people learn to manage diabetes, attendance rates are very low.
Clinical Commissioning Groups (CCGs) in North West London are working with three innovative digital health companies, OurPath, Oviva andChanging Health to provide digital solutions for patients with diabetes to improve self-management of diabetes.
Changing Health is on the 2017-18 DigitalHealth.London Accelerator programme, while Our Path and Oviva took part in the 2016-17 programme. The Accelerator is a partnership between London’s three AHSNs (Health Innovation Network, Imperial College Health Partners and UCLPartners), MedCity, CW+, and Guy’s and St Thomas’ Charity. The companies went through a rigorous application process with evaluation by clinicians, commissioners, and patients.
OurPath is a 12-week digital behavioural change programme aimed at preventing the onset of type 2 diabetes, along with helping people living with type 2 diabetes, through education, healthcare tracking, and health coaching via an app.
Oviva Diabetes Support is a 12-week education and behaviour change programme for people with type 2 diabetes, delivered by a diabetes specialist dietitian and supported by online learning resources and the Oviva app.
Changing Health provides behaviour change programmes for Type 2 diabetes, pre-diabetes, and weight management over 12 weeks or 12 months. The service combines personalised health coaching rooted in behavioural psychology with evidence-based digital education, focusing on sustaining long-term lifestyle change.
Impacts / outcomes
“What we have done is demonstrate the power of near real-time analytics on improving the health of populations.” Dr Tony Willis, clinical lead for diabetes for the North West London Collaboration of CCGs
83% of people in trials completed the OurPath programme and submitted information on weight loss and increased activity levels, both recommended steps to delay the progression of diabetes. At the date of analysis, of those patients that had taken part in the programme for three months, 61% had submitted a weight reading and achieved a mean weight loss of 6.7%, and increased their activity levels by 22%. After six months, 52% had achieved a mean weight loss of 8.2%. Data on the reduction of DNA rates is still being collected and analysed.
The OurPath pilot aims to replicate these successes, helping patients to better manage their disease and ultimately improve their quality of life.
Oviva Diabetes Support has demonstrated high uptake rates, and impact on weight loss, blood glucose and other clinical markers. From 1,453 referrals to date, the programme has achieved approximately 70% uptake. In terms of clinical outcomes at six months post-completion, average reduction in HbA1c (an indicator of blood glucose levels) is 13 mmol/mol and bodyweight loss is 4.5% (n=85). Initial evaluation of clinical outcomes in North West London indicates that these outcomes are replicated in this pilot, and collection of outcomes is ongoing.
Changing Health saw high levels of self-referral (60% of users recruited), which was useful for case-finding specific patient cohorts with minimal administrative burden for the GP practice. After 12 weeks of service use, active users’ Patient Activation Measures (PAM scores) increased on average by 10 points, from a mean pre-enrolment score of 56 to a mean post-participation score of 66. A one point increase in PAM score correlates to a 2% decrease in hospitalisation and a 2% increase in medication adherence.
At 12 weeks, Changing Health users reduce their HbA1c by an average of 6.8 mmol/mol (0.6% reduction), with an average reduction in body weight of 3.1% over the same period. At six months, this weight loss is sustained. 70% felt their coach helped them identify barriers to change, while 85% of users are confident Changing Health will help them achieve their goals.
It is intended that the findings of the OurPath, Oviva and Changing Health pilots will be replicated across the CCGs, and will lead to significant change in the way patients manage their condition.
The North West London Collaboration of CCGs commissioned an independent evaluation of the pilot, which was undertaken by Imperial College Health Partners