How to successfully offer diabetes prevention at a distance

Sara Berg, MS , News Editor

With an unprecedented and rapid transition to telehealth services across the country, many health care organizations have had to change how they approach prediabetes care. For Vidant Health in Greenville, North Carolina, that has meant quickly shifting patients from an in-person National Diabetes Prevention Program (DPP) lifestyle-change program to a new virtual format—also known as distance learning which is offered through the internet and telephonic conference—while adapting classes to meet changing priorities.

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In mid-March, as soon as in-person events were put on hold due to COVID-19, Vidant Health—a nonprofit 1,447-bed hospital system that serves more than 1.4 million people—successfully transitioned to distance learning to continue to care for people with prediabetes. Vidant’s virtual National DPP lifestyle change program is a free year-long intensive program with weekly classes that provide group support to learn more about healthier eating, physical activity, stress reduction and coping skills.

“I didn't really think twice about going virtual—we just did it, even though it wasn't my strong point,” said Susan Houston, a lifestyle nurse specialist at Vidant. “COVID-19 helped push us towards advancing our DPP delivery into the virtual world. The learning curve was educational for both coach and participant.”

Leaders at Vidant always remained committed to the idea of keeping patients engaged in diabetes prevention. The decision was “to keep going and figure out how to do it,” said Brenda Leigh, director of lifestyle medicine at Vidant. Precisely how to implement the virtual program “was a trial and error process.”

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The AMA’s Diabetes Prevention Guide supports physicians and health care organizations in defining and implementing evidence-based diabetes prevention strategies. This comprehensive and customized approach helps clinical practices and health care organizations identify people with prediabetes and manage the risk of developing type 2 diabetes, including referring people at risk to a National DPP lifestyle change program based on their individual needs.

Additionally, the AMA, North Carolina Medical Society and other local organizations are supporting a new statewide initiative, DiabetesFreeNC, which aims to put an end to type 2 diabetes in North Carolina.

Here is what the professionals at Vidant have learned about how to make their DPP lifestyle change program a success while keeping DPP participants, team members and community members safer at home.

“It’s hard to do a group class when people show up late,” said Houston. “Part of the details of the class is laying out the etiquette of online classes and trying to be mindful, patient and courteous to everyone.”

“To alleviate challenges or stressors with virtual classes, it helps to be organized, have some pre-class practice with the virtual platform, be on time, courteous, patient, set virtual classroom ground rules, have a plan B, and be flexible,” she said. “The DPP should be worry and stress free, informative, fun, and engaging.”

“Etiquette is important because I’ve noticed in the first month of COVID, nobody understood what was going on with online meetings,” said Leigh, adding that use of video is “especially important with a group class like the lifestyle change program where part of the class is interaction.”

“As a leader, you look at how your room is responding to what you’re talking about,” said Leigh. “It helps you to either speed up, slow down or change topics. It’s really hard to read cues when you’re doing a WebEx or Zoom meetings and you can’t see people’s eyes.”

Learn more about five barriers to launching a virtual diabetes prevention program.

“We have to remind ourselves that it’s not a teaching class—it’s making sure we’re including everyone in this learning platform,” said Houston. “Some people are new to the virtual world and learning, so encouragement, discussion and a family member may be necessary to get started.”

For example, some people use their phone to connect to the classes if their internet is not cooperating, which prevents them from seeing what is shared on screen.

In turn, that leads to another complication: phone data.

“I had somebody call about our program and she’s very interested, but she only has so much data on her phone. I hadn’t come across that yet,” said Houston. “I don’t want people to have to buy anything extra to be in this program, so for this lady I’m going to have to call her back to see how we can work around that.”

It is important to not forget the little things, because even losing one pound is something to be celebrated—it is a positive moment on a person’s path to making healthy changes. This is especially true during the COVID-19 pandemic when many people are experiencing added stress.

“If people maintain their weight—while it’s not what the program’s about—I think that’s a huge positive because of the stressful situation that we’re living in right now,” said Leigh.

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Learn more about how patients can start—and stick with—key lifestyle changes, including making small modifications.

As with in-person classes, lifestyle coaches must be able to read the room to gauge how participants are feeling or reacting.

“At the beginning of each session I check in with everyone to find out how they are doing, if they had any concerns about last week’s topic, their action plan, or life in general,” said Houston. “Stressful times with COVID-19 have given all of us a new normal and one thing I ask people at enrollment is if they are ready to change up what they normally do.”

“All participants are at different stages of interaction. Some are quiet and some are commenting on everything,” she said. “Just like in a classroom setting, you want to make sure every voice is heard.”

Additionally, there is an opportunity to call or email after classes to get “some great feedback from the participants,” she said, which helps frame future sessions.

Read about how the pandemic shines spotlight on chronic disease prevention priority.

“When you’re talking about COVID and change in what’s happening, a lot of these people aren’t able to exercise the way that they used to,” said Leigh. “To help, we’ve connected the group from the lifestyle change program into our virtual exercise classes.”

“Vidant has three wellness centers and they are obviously closed during this time, but we’ve moved our classes to virtual and by doing so it opened it up to anybody, not just members of the wellness center,” she said.

The available classes range from yoga to Tai Chi and boot camps “so people that normally couldn’t afford to go to the gym or maybe had never even tried yoga can now participate,” said Leigh.