Diabetes Engagement and Activation Platform for Implementation and Effectiveness of Automated Virtual Type 2 Diabetes Self-Management Education: Randomized Controlled Trial

BACKGROUND: Patients with type 2 diabetes require recommendations for self-management education and support. OBJECTIVE: In this study, we aim to design the Diabetes Engagement and Activation Platform (DEAP)—an automated patient education tool integrated into primary care workflow—and examine its implementation and effectiveness. METHODS: We invited patients aged 18-85 years with a hemoglobin A(1c) (HbA(1c)) level ≥8 to participate in a randomized controlled trial comparing DEAP with usual care. DEAP modules addressing type 2 diabetes self-management education and support domains were programmed into patient portals, each with self-guided educational readings, videos, and questions. Care teams received patient summaries and were alerted to patients with low confidence or requesting additional help. HbA(1c), BMI, and systolic and diastolic blood pressure (DBP) were measured. RESULTS: Out of the 680 patients invited to participate, 337 (49.5%) agreed and were randomized. All of the 189 intervention patients accessed the first module, and 140 patients (74.1%) accessed all 9 modules. Postmodule knowledge and confidence scores were high. Only 18 patients requested additional help from the care team. BMI was lower for intervention patients than controls at 3 months (31.7 kg/m(2) vs 32.1 kg/m(2); P=.04) and 6 months (32.5 kg/m(2) vs 33.0 kg/m(2); P=.003); improvements were even greater for intervention patients completing at least one module. There were no differences in 3- or 6-month HbA(1c) or blood pressure levels in the intent-to-treat analysis. However, intervention patients completing at least one module compared with controls had a better HbA(1c) level (7.6% vs 8.2%; P=.03) and DBP (72.3 mm Hg vs 75.9 mm Hg; P=.01) at 3 months. CONCLUSIONS: The findings of this study concluded that a significant proportion of patients will participate in an automated virtual diabetes self-management program embedded into patient portals and health systems show promise in helping patients manage their diabetes, weight, and blood pressure. TRIAL REGISTRATION: ClinicalTrials.gov NCT02957721; https://clinicaltrials.gov/ct2/show/NCT02957721