Completed Gateway Research
• The Diabetes and Technology for Increased Activity (DaTA) Study
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The Diabetes and Technology for Increased Activity (DaTA) Study
Research Team:
Robert Petrella, MD, PhD, Principal Investigator, Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute
Claudio Munoz, MD, PhD, Co-Investigator and Director, Gateway Rural Health Research Institute
Elizabeth Russell-Minda, MA, Research Coordinator, Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute
Emily Read, MSc candidate Kinesiology, University of Western Ontario
Melanie Stuckey, PhD candidate, Kinesiology, University of Western Ontario
Robyn Fulkerson, MBA, Director, Product Development, Sykes Assistance Services Corporation
Peter Kleinstiver, PhD, President, Katalyst Health Technology Assessments
Sandra Kleinstiver, ART, Katalyst Health Technology Assessments
Year the Study was Conducted: January – May 2009
Executive Summary
Health care provision deficits, physician shortages and increasing levels of diabetes and other chronic diseases in rural communities have prompted researchers and policy makers to search for feasible solutions. Previous research has shown important connections between diabetes, and the development of diabetes (pre-diabetes and the metabolic syndrome) and the risk for developing varying types of cardiovascular complications (CVCs). Since the causes of pre-diabetes and metabolic syndrome for a majority of individuals are uncontrolled hypertension, poor diet, and insufficient physical activity, improvement in health status essentially requires lifestyle change.
The high prevalence of prediabetes and metabolic syndrome in the overall population underscores an urgent need to develop comprehensive efforts directed at behavioral change, controlling hypertension, improving nutrition and physical activity. Despite positive evidence that diabetes is preventable with simple lifestyle management change, its adoption and implementation has been disappointing, partly because success depends on changing habits and attitudes and access to a supportive environment (i.e., health promoters, facilities and equipment). In light of these findings, the research teams at the Lawson Health Research Institute and the Gateway Rural Health Research Institute have joined together to conduct an industry-linked pilot research study in rural Southwestern Ontario. This pilot falls within a larger multicentre international research initiative (ARTEMIS) which aims to determine and implement strategies to reduce the CVCs of type 2 diabetes across a continuum of populations and factors.
Our pilot starts at the community level—the Diabetes and Technology for Increased Activity (DaTA) study assesses the effects of a 12-week lifestyle modification (exercise) and technology intervention for the prevention of diabetes and CVCs and improved well-being, in 24 subjects with pre-diabetes risk factors, in Huron County, Ontario. Our research teams seek to determine the usability and practicality of interactive wireless, remote health-monitoring technologies with a specific at-risk population, in a rural environment to prevent the onset of diabetes. This type of innovative health intervention may have wide-ranging possibilities for the prevention of other types of chronic disease and health care delivery in regions of need. Participants range in age from 30-72 years, with a mean age of 56.6 (SD ± 9), and are expected to meet at least two out of four of the following pre-diabetes risk factor criteria: abnormally elevated blood pressure, blood glucose, and cholesterol levels, and overweight.
The principal wireless device used by participants in the study is a BlackBerry®, which communicates with two Bluetooth-enabled health-monitoring devices—a blood pressure monitor and a glucometer. Participants also use a pedometer (daily steps) and a Suunto® heart rate monitor (memory belt) to assess their heart rate and levels of physical activity. Wirelessly transmitted health monitoring measurements are able to be viewed by the study investigators within seconds, via a health monitoring database (Healthanywhere, IgeaCare, Inc), and by the patients , via their BlackBerry. Participants are able to view log books of their readings, as well as graphical outputs of their measurements. Reminders and physical activity “staging” questionnaires are sent to their BlackBerry from a nurse or case manager from the monitoring database (see Figure 1).
The preliminary results from this pilot study indicate excellent patient compliance with the technologies and lifestyle intervention recommendations (increased exercise), based on the daily/weekly measurements captured in the health monitoring database and from their visits to the research clinic. Preliminary compliance data based on the results from thirteen participants who completed the study are as follows (listed in percentages of completed readings): 96.9 ± 7.29% of morning glucose; 97.27 ± 8.38% of bedtime glucose, 93.98 ±17% of blood pressure readings; 96.87 ± 5.24% of pedometer readings; and 91.15 ± 10.93 % of all body weight readings were submitted.
The technology survey indicated that despite low levels of experience with personal digital assistants or Blackberrys, participants were comfortable using the technology. It further indicated that remote monitoring improved their overall sense of well-being. Reasons for missed readings were shift work, technology failure and forgetfulness. These initial findings indicate an overall willingness by participants to invest their time in at-home health monitoring measurements and increase their levels of exercise. Furthermore, the database-generated health reports are proving to be valuable two-way tools for communication between the patients and their primary care physician or other health care providers.
For those without a care provider, the interventional tools and methods used in this study have given these participants an awareness of lifestyle modification recommendations and their overall physical health, which may not have been otherwise available to them in this particular environment. The results from this pilot—and larger, planned research studies—may help direct coordinated strategies for future chronic disease management projects such as global database projects and more localized community-based social marketing plans. The facilitation of chronic disease management initiatives will ultimately involve input from key stakeholders including primary care providers, diabetes educators, Local Health Integration Networks (LHINs), community organizations and leaders, and other types of chronic disease health care providers.