Use of an innovative health technology tool for behavior change counseling to prevent diabetes

Background: Diabetes mellitus (T2DM) affects 25.8 million people in the US; another 79 million adults have prediabetes. New technologies and electronic platforms for enhanced physician counseling can promote behavior modification to delay the progression of prediabetes to T2DM. Objective: To assess whether a technology-assisted goal-setting tool embedded in the electronic health record (EHR) encourages behavior change to reduce T2DM risk among prediabetic patients. Methods: A pilot randomized, controlled study, Avoiding Diabetes Thru Action Plan Targeting (ADAPT), is currently underway to promote action plan discussions between patient and provider for patient-selected behavior change goals and includes web-based personalized feedback to support goal implementation. Primary care providers were randomized to intervention (ADAPT) tool activated when they saw enrolled patients, or control. Baseline data about patients' health and behaviors, including pedometer data, were collected. Results: To date, 46 patients (mean age= 43 years, 79% female, 15% White, 35% Black, 39% Hispanic) and 12 clinicians from two primary care practices have enrolled in the study. Patients' mean baseline BMI was 35.9 (SD=9.3), hemoglobin A1c was 5.9% (SD=0.3), and baseline number of steps/week taken was 6632. 100% of intervention clinicians engaged with and completed the ADAPT tool. All 27 intervention patients created action plans with their providers, and to date, 59% (n=16) successfully implemented their goals on the ADAPT website. Patients reported favorable attitudes about the email reminders and pedometer use for achieving their behavior change goals. Conclusion: ADAPT provides a novel electronic pathway for counseling patients with prediabetes to enact behavior change, and can be disseminated at point of care through EHRs. Preliminary data and initial feasibility testing show successful uptake and implementation by providers and patients. Computer applications and novel technological approaches like ADAPT offer fresh strategies to address public health concerns over the rising rates of diabetes in the US.