NHS Glos. CCG: Type 2 Diabetes & Prediabetes

Kirstie Tew, MSc., Abby Barton, BSc., & Sophie Middleton

Executive Summary

Background

Physical activity is fundamental to the treatment of Type 2 Diabetes and should be prescribed by a healthcare professional at initial diagnosis, prior to medications (Nathan et al., 2009), and continue throughout the management of the condition (Duclos et al., 2015; Andrews et al., 2011). NHS Gloucestershire Commissioners felt that KiActiv® Health could be a valuable tool to support individuals who have been diagnosed with Type 2 Diabetes and Prediabetes, in order to better manage their condition and reduce the likelihood of further complications.

Innovation

KiActiv® Health is a personalised and guided online behaviour change service that empowers participants to optimise everyday physical activity in the context of their condition. KiActiv®’s patented technology evaluates minute-by-minute physical activity data from a validated wearable monitor, which is displayed instantly in the user’s personalised online dashboard, and is available 24/7 to provide meaningful and actionable feedback. Patients are also supported remotely by phone calls with a dedicated KiActiv® Mentor at 6 key time points during the 12-week programme, to help them build an understanding of the value of their daily activities and the confidence to plan, monitor and improve. At the end of the 12-weeks, the patients retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.

Purpose/objective

To provide an accessible service to enable patients diagnosed with Type 2 Diabetes or Prediabetes to improve self-care through the optimisation of their everyday physical activity.

Methodology

Eligible patients were invited to participate in KiActiv® Health via a letter or email sent out by their GP practice, or through community services. Once enrolled patients were sent a wearable activity monitor, before participating in the 12-week KiActiv® Health programme. They were supported at key time points throughout by a trained KiActiv® mentor. Data was analysed from a range of sources: the KiActiv® Health platform, and KiActiv® Mentor calls.

Key Findings

  • Demographics: 554 patients started KiActiv® Health (241 females, 313 males), average age = 63 years, average body mass index (BMI) = 32.5kg/m2.
  • Completion: 422 patients (76.2%) (173 females, 249 males) have completed the 12-week programme and 11 (2.0%) are currently within the 12-weeks.
  • Engagement: The use of the technology was excellent and included 92.5% of days being classed as having complete data.
  • Patient Reported Benefits:
    • Weight Loss average of 3.2kg over the 12 weeks.
    • Improvements in HbA1c and a reduction in blood glucose levels to pre-diabetic levels.
    • Reduction in diabetes-specific medication use.
    • An increased awareness of all movement, not just exercise.
    • Understanding the accessibility of everyday physical activity, and finding more enjoyment in daily activities.
    • Benefits to other aspects of lifestyle such as improved sleeping patterns and healthier eating habits.
    • Feelings of empowerment, autonomous choice and support from the KiActiv® Mentor, which promoted sustainable behaviour change.
    • Improvements in quality of life.
    • Reduced Fatigue.
    • Improved Mental Health.
  • Physical Activity Data:
    • 100% of patients improved their physical activity in 1+ dimensions.
    • 100% of patients improved their physical activity in 3+ dimensions.
    • 88% of patients improved their physical activity in 4+ dimensions.
    • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 67 complete days were:
      • Non-Sedentary Time: +29hrs 43mins (+16%)
      • Moderate Activity: +13hrs 24mins (+40%)
      • Moderate Bouts: +9hrs 22mins (+851%)
      • Calorie Burn: +5,867kcals (+3%)
    • 86.7% of the group achieved physical activity levels exceeding 150 mins of Moderate Activity per week, which is associated with reductions in HbA1c of 0.89% (Umpierre et al., 2011).

Amongst the 121 patients who did not complete the full 12-week programme, some patients indicated that ill health was the reason for withdrawing. Others cited difficulties or a lack of confidence with technology, and some stated that they were simply too busy to find the time to engage with the programme.

Conclusion

It is widely accepted that physical activity is an effective method for managing Type 2 Diabetes and is recommended in the NICE Guidelines (NICE NG17, 2015; NICE NG28, 2015). Physical activity has been shown to directly improve glycaemic control (Kujala, 2009) as well as reducing body weight, which is crucial for the control of Type 2 Diabetes (Wilding, 2014). The physical activity improvements demonstrated by this cohort are associated with reductions in HbA1c that are comparable to those seen with oral antidiabetic medication (Sherifali et al., 2010).

KiActiv® Health increased self-management skills and participants received person-centred care along with tailored individual advice on optimising their daily physical activity to improve self-management of their diabetes and any comorbidities. The remote nature of KiActiv® Health overcomes the travel barrier, ensuring participants are supported from the safety of their own homes. Not only is this particularly pertinent due to ongoing COVID-19 restrictions but reducing our reliance on transport to receive care will also reduce carbon emissions, supporting the vision for a healthier planet. Ultimately, KiActiv® Health provides support to those diagnosed with Type 2 Diabetes to optimise their physical activity for the good of their health, which can help to reduce the burden of further associated health complications in the future.

29th November 2021