Sugar Smart for Life

Sugar Smart for Life is a six-month, technology-based behavior change intervention targeted at people in the community who have prediabetes. Participants are recruited through the Healthy Hub, a one-stop screening and referral-to-care kiosk in the lobby of West Kendall Baptist Hospital that also operates at mobile locations in the community. The intervention uses a suite of mobile applications to assess, monitor and message program participants. Participants are assessed through the Encounter Health Risk Assessment app at baseline, three and six months using the American Heart Association’s Life’s Simple 7 (LS7), a measure of heart health that has been proven to improve overall health. LS7 assesses seven domains: blood pressure, blood sugar, cholesterol, Body Mass Index (BMI), smoking status, exercise and nutrition. In addition, participants receive A1c and lipid profile assessments. Based on their results, Sugar Smart for Life participants receive coaching from a nurse on lifestyle modifications that can improve their LS7 scores. The nurse also creates a wellness plan in the Engage app that identifies daily and weekly tasks to improve participants’ biometric results. These include glucose testing, weighing, exercise and nutrition tasks that are completed at home. Engage also allows the nurse to remotely monitor task compliance, send reminder and encouragement messages, and schedule follow-up assessments. Program participants report their progress on their tasks through HealthBook, a consumer-facing mobile app that contains their biometric results and wellness plans. They are also asked to participate in educational workshops to improve their prediabetes knowledge and learn mindfulness techniques that can support healthier lifestyles. At the conclusion of the six-month program, all Sugar Smart for Life members are scheduled to return at 12 months to reassess whether they have maintained improvements made through the program.

The goal of Sugar Smart for Life is to reduce the rate of diabetes in our community by empowering those with prediabetes to make lifestyle changes that may prevent or delay onset of the disease.

These findings suggest that this technology-based intervention is well-received by patients at high-risk for developing diabetes in terms of satisfaction, delivering appropriate health education, and supporting and encouraging positive health behavior changes.

In the first pilot project, approximately half of our total participants remained fully engaged in our 6-month program. While we wish to improve participant engagement in the future – building on lessons learned since the inception of our program – we believe this level of engagement has the potential to demonstrate important and measurable population health improvements when scaled to much larger cohorts and populations across our community.

Within this relatively short 6-month timespan, engaged participants demonstrated significant improvements in several clinical cardiometabolic outcomes. For example, these individuals showed a 3.3% improvement in their HbA1c levels (baseline mean level of 6.0% vs. 6-month mean level of 5.8%), an 18.8% improvement in their LDL “bad” cholesterol levels (baseline mean level of 101 mg/dL vs. 6-month mean level of 82 mg/dL), a 5.2% improvement in their HDL “good” cholesterol levels (baseline mean level of 58 mg/dL vs. 6-month mean level of 61 mg/dL), as well as a 10.5% improvement in weight (baseline mean weight of 183 lbs vs. 6-month mean weight of 179 lbs). In total, this group lost a combined weight of 105 lbs, and also showed a 16.7% improvement in high triglyceride classification. It is important to note that the magnitude of these improvements within a 6-month period is clinically relevant, given that, on average, at-risk prediabetic individuals tend to show increases over time in these metrics and that decreases in these metrics as a result of behavior change often take longer periods of time to manifest. In addition to observed clinical improvements, important behavioral changes were noted as well. For example, 55.6% to 61.1% of participants reported gaining a much greater understanding of how meal plans affect blood sugar control, the role of exercise in prediabetes care, as well as the overall prevention and treatment of high blood sugar. We will continue to track our program participants and reassess them at 12 months to evaluate additional changes and/or maintenance of observed improvements.

Overall, these engaged individuals showed an average 25% improvement in their Life’s Simple 7 Score (baseline mean score of 8 vs. 6-month mean score of 10). These improvements suggest an aggregate projected yearly cost savings of $163,129 ($9,063 per participant), calculated as a function of improvements in weight, blood pressure, cholesterol, blood glucose, physical activity and diet. This translates into a net yearly health cost savings of $8,379 per participant, accounting for the $684 per participant program cost. Of note, the yearly cost savings associated with program participants’ reductions in blood glucose level alone was projected to be $63,200.

Satisfaction survey responses also showed that 92.3% of participants reported that the program’s mobile app technology was either “very” of “extremely” helpful in aiding their compliance to the program and associated health behavior changes, 94.4% reported they would use the app at least once a week (55.6% reported they would use the app everyday), and 88.9% reported they would be “extremely” or “very” likely to recommend this app to a friend. Additionally, all but one participant either “agreed” or “strongly agreed” that our mobile app technology is likely to (1) increase awareness of the importance of addressing prediabetes, (2) increase knowledge and understanding of prediabetes, (3) change attitudes toward improving prediabetes, (4) increase intentions and motivations to address prediabetes, and (5) increase healthy behaviors related to prediabetes as well as decrease unhealthy behaviors. Participants gave the app a 4.2 out of 5-star rating.

Importantly, this intervention also resulted in demonstrable improvements in key behavioral as well as clinical cardiometabolic risk factors associated with future diabetes and cardiovascular disease risk, and thus shows promise in improving the overall health (and associated costs) for this patient population above and beyond standard medical care.