Sodexo’s Digital Telehealth Diabetes Prevention Program—Path to Improvement

By Kimberly Wolf, MS, RD, LDN, CDE

Eighty million people—that’s twice the number of people living in California—have prediabetes and are on the path to developing Type 2 diabetes. 

Without making changes in their lifestyles,15 to 30% of the people in the U.S. who have prediabetes will develop Type 2 diabetes within five years. The American Diabetes Association estimated that in 2018, more than 500 million people worldwide already had Type 2 diabetes. Over time, diabetes can lead to heart disease, stroke, kidney disease, and other serious illnesses and complications, including kidney failure, blindness, and nerve damage leading to amputation. Prediabetes needs to be taken seriously too, as it also raises the risk of heart disease and stroke.

But it doesn’t have to be that way. Initiatives like the National Diabetes Prevention Program (DPP) provide education, encouragement and structure to help people with prediabetes lose weight and maintain that weight loss—a significant step in preventing the development of the disease.

Sodexo Tackles Prediabetes Using Telehealth

Sodexo, a world leader in quality of life services, wanted to determine if the National DPP could be implemented using telehealth. 

While telehealth has been used to diagnose and treat illnesses, there is a significant opportunity to use this technology to help more people with prediabetes participate in DPP. 

Sodexo created a digital diabetes pilot program with the goal of helping participants with prediabetes lose 5% of their initial body weight within one year. For a 200-pound person, that’s just 10 pounds.

Participants who were identified as being at risk for diabetes through their insurance company’s online assessment were invited to join the year-long program. Six of Sodexo’s registered dietitians became certified DPP lifestyle coaches.

Using the CDC-based curriculum, the coaches facilitated eight classes that taught healthier lifestyle habits and behavioral adjustment coping strategies. The 19 program participants were given a digital scale, a wearable device, and a mobile health app to track progress. 

Throughout the program, participants learned about healthy eating and meal preparation, stress/behavioral management, and daily activity through live-streamed, interactive classes. Participants attended classes via their laptops or mobile devices at a regularly scheduled time. During the classes, participants interact with the coach and other class members.

“The DPP class was designed to fit into the participants' lifestyle where they develop healthy habits.  The 12-month commitment gives participants adequate time to turn learned behavior into a part of life.” — Kimberly Wolf RD, LDN, CDE, Sodexo’s DPP Lifestyle Coach 

At home, participants weighed themselves on a digital scale, uploaded photos of their meals and snacks as a food journal, and monitored daily physical activity by syncing their Fitbit to the mobile app. Participants could use the platform to message the coaches with questions or concerns.

“The benefit of a small group is to make the participants feel supported and encouraged that they have the ability to implement healthy lifestyle strategies into their lifestyle,” Wolf says. “If a participant had voiced a concern in an area such as inadequate time to participate in physical activity, another participant could talk about how they altered their daily routine and offer different activity ideas. The group support is a big component of the diabetes prevention program.”

As an outcome-based program, Sodexo reported metrics to the CDC. 

By the end of the program, 7 participants (37%) finished the program and hit the CDC goal of losing 5% of their body weight. Some participants lost weight and hit the 5% goal early in the program; however, they regained some weight. These results closely matched the National DPP’s in-person program results for weight loss (35.5% of participants lost 5% of their body weight) while providing participants the flexibility to attend class from any location via their smartphone or laptop.

5 Reasons to Use Telehealth for Diabetes Prevention at Your Hospital

Healthcare organizations must consider innovative approaches to preventing diabetes. Remote telehealth programs can be useful in helping patients and your hospital avoid the financial and societal cost of diabetes.

1. Telehealth can be used even if the participants aren’t local, which increases the outreach of the program. 
2. Telehealth requires fewer hospital resources. Essential tools are coaches and the technology that enables the coaches to communicate remotely with patients.
3. Telehealth provides flexibility to participants—they do not have to worry about the weather or transportation issue—issues which can decrease the likelihood of attendance.
4. Telehealth allows participants to contact lifestyle coach via messages on the telehealth platform between sessions if they have questions or concerns, without waiting until the next session. This access to the coach helps participants stay motivated.
5. Populations who are especially at risk can be identified, and a lifestyle coach can deliver the program even if local resources aren't available.

Success Factors for Using Telehealth to Prevent Diabetes

What does it take to create a telehealth program that works? Here are four critical factors for conducting a successful telehealth program for diabetes prevention:

1. Get the right coaches. Coaches in both in-person and telehealth programs should be certified lifestyle coaches. With Sodexo, the coaches are also Registered Dietitians. In addition to having the educational credentials, coaches encourage interaction remotely and create a supportive environment.
2. Use intuitive, cloud-based technology. Platforms with good user experience are crucial to participation. Participants may join the classroom from any location and device. They can use these devices to track eating and activity progress, and having those devices, especially mobile devices, within reach increases the likelihood of participants recording the data. 
3. Frame the process positively. “Food is medicine in a way, so if you choose healthier foods, you can help improve or prevent disease,” Kim Wolf said. "Also, I didn't typically use the word 'exercise.' I focus on being active. It can be just movement, really any kind."
4. Establish individual goal-setting components. With medical nutrition therapy, everyone’s goals will be different, so their programs should be tailored accordingly. Some people are going to need more education or more check-ins. The key is to meet each person where they are and provide an individual path to the finish line.

Diabetes is a global epidemic, one that has and will cause people, healthcare organizations, and society in general immeasurable physical, psychological, and financial damage. Innovative telehealth programs like Sodexo’s are one of the most promising methods to help hospitals stem the burden of diabetes in their service areas while giving people with prediabetes the education, support and tangible next steps to improve their health.

Learn more about our Registered Dietitians, and how they promote positive clinical outcomes.