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Scalability Failures with the In-Person Diabetes Prevention Program

The Case for A.I and Digital Solutions

The Diabetes Prevention Program is recognized by the Centers for Disease Control and Prevention (CDC) as an effective way to prevent or delay type 2 diabetes among individuals with prediabetes or high type 2 diabetes risk. The DPP has been shown to lower 3-year diabetes risk by over 50%. Furthermore, it is cost-effective, with an estimated a $1,595 return on investment within 5 years [1].

The DPP can clearly improve health outcomes and address the $327 billion annual burden of diabetes in the U.S. Plus, over 86 million – 1 in 3, American adults have prediabetes, and most of those could likely benefit from the program. Why, then, is the DPP not ubiquitous? A shortage of in-person locations and lifestyle coaches can be a barrier to increased participation rates nationwide.

Crunching the Numbers: Shortages of Coaches and Sites

The numbers are not definitive, but the conclusion seems clear: there are simply not enough lifestyle coaches reach the 86 million Americans who are prediabetic. There is variation in aspects such as the number of participants per DPP class and the number of classes offered per site or organization, but here are some of our calculations.

“Thousands of Coaches”

The CDC says that “there are thousands of trained lifestyle coaches nationwide.” Let’s assume that the CDC means 10,000 coaches. With 86 million Americans with prediabetes, each lifestyle coach would need to reach an average of 8600 participants in their DPP programs – which, as a reminder, include a minimum of 22 sessions over the course of the year.

In-Person Coaching: A Mathematical Impossibility!

Doing the calculations, assuming an average class capacity of 20 participants… Each lifestyle coach’s 8,600 participants would be split into 430 classes. To hit those 22 annual sessions, each coach would need to conduct 9,460 classes. At an hour per class, that adds up to each coach working nonstop (no sleeping or eating) for 394 days per year to reach their allotted participants. Oh, and a year has only 365 days!

That is right: with these numbers, it would be physically impossible to bring a DPP to all prediabetics.

Likely Inadequate Reach of Diabetes Prevention Program Coaching

Going back to an estimate of 10,000 lifestyle coaches, let us assume, generously and unrealistically, that they teach DPP sessions full-time (and have no other professional duties), spend two hours per session preparing and teaching, and have 20 participants per class. Using the standard full-time year of 2,080 hours, that would allow for 47 separate 22-session courses, serving a total of 940 participants. That number is not even 11% of the number they would need to reach to serve the entire population of prediabetes patients.

Even Greater Shortcomings with Different Calculations

Approaching the estimates from a different direction, let’s take a look at a large study examining the nationwide effects of the DPP. The study included data from 435 DPP organizations that served 35,844 participants, or an average of 82.4 participants per site [2]. (The estimate of 82.4 participants per site seems reasonable when checked against a different review article looking at sites with an average of 70.9 participants per site [3]).

Extrapolating that ratio to the approximately 1,800 organizations that currently have CDC DPP recognition, there would be an estimated 148,320 prediabetic patients currently participating in the DPP. That value is a measly 0.17% of the 86 million adults with prediabetes. That means fewer than 2 out of every 1,000 individuals with prediabetes are benefiting from the DPP!

Impending Shortages of Lifestyle Coaches

A reason for the inadequate number of DPP lifestyle coaches may be trouble obtaining certification. An individual must go through a recognized training program to become a DPP lifestyle coach. The CDC has signed a memorandum of understanding (MOU) with 9 organizations that offer online or on-site training [4]. This number of organizations may seem like a small number to serve the entire country, and it seems even more inadequate when considering limitation such as:

  • Offering only 4 to 12 sessions per year.
  • Capping enrollment at numbers such as 24 participants per session.
  • Meeting synchronously at times that may be impossible for potential enrollees to attend and therefore preclude them from being coaches.

The Case for Digital Solutions

A digital DPP can likely address the shortfalls in numbers of DPP lifestyle coaches by dramatically increasing scalability. A digital DPP can serve vastly greater numbers of prediabetes patients and reduce the ratio of participants to coaches that are required for effective education and lifestyle change.

A mobile-based DPP that is delivered entirely digitally requires far fewer lifestyle coaches, and Lark’s 2017 study in the JMIR proved that this model has equivalent clinical outcomes to in-person programs.

Other reasons why a well-chosen digital DPP can improve DPP adoption nationwide include:

  • Ease of implementation, with seamless integration into your organization and assistance with cost or insurance if applicable.
  • Support when setting up the program, associated digital scales or other devices, and throughout the program.
  • Lower cost when compared to in-person interventions that require payment for facilities and personnel.
  • Potential for higher engagement, due to participant convenience, and better results.

Regardless of which estimates you use, it seems clear that there is a shortfall of trained lifestyle coaches, and in this economy, a shortage of workers overall. Also clear is that a digital DPP can be a simple, quick, and effective solution. A digital DPP has immense scalability because it can get more mileage from each trained lifestyle coach to serve more participants, and it is easy for organizations to implement regardless of their expertise in this area. Shouldn’t you be looking into digital solutions?

Lark’s Digital DPP

With tens of thousands of participants, Lark’s DPP is the most scalable and the fastest growing. It is based on a combination of A.I and human coaches, plus a connected device universe to track participant data in real time. The A.I behavior change is built with Cognitive Behavioral Therapy led by the former head of the Altruism lab at Stanford University. The ability to replicate human coaches for routine interventions while involving them for more significant interventions has led to scalable positive outcomes that has been making a real impact for almost 100,000 of the 86 million prediabetics.

August 31, 2018 Outcomes Update

  • Effective: 6.53% Body Weight Loss (CDC target is 5%)
  • Engaging: 7.6 Sessions per Month (CDC target is 22 per year)
  • Scalable: 13x Year Over Year Participant Growth
  • Popular: Apple’s “Top 10 Apps” and Google’s “Best of the Year”

Reference

1. https://www.cdc.gov/pcd/issues/2016/15_0357.htm
2. https://care.diabetesjournals.org/content/diacare/early/2017/07/20/dc16-2099.full.pdf
3. https://care.diabetesjournals.org/content/diacare/early/2012/12/19/dc12-1250.full.pdf
4. https://www.cdc.gov/diabetes/prevention/lifestyle-program/staffing-training.html