Social Technology for Diabetes Prevention

Diabetes mellitus is a common and serious metabolic disorder that impacts an increasingly large number of adults worldwide. The prevalence of diabetes has been increasing globally over the past few decades. Type 2 diabetes specifically, has become increasingly prevalent in China making this a geographic location of diabetes prevention interest. Risk factors such as the dietary choices in certain Chinese provinces, increased oil-fried vegetables, for example, have been noted to contribute to this increasing prevalence even in otherwise low-risk individuals. In addition to diabetes, global prevalence of pre-diabetes is also increasing; Pre-diabetes is a metabolic condition defined by either impaired glucose tolerance, impaired fasting glucose, or hemoglobin A1C values in the prediabetes range, that can often develop into diabetes. Research suggests that both individuals with diabetes as well as prediabetes, are at higher risk for cardiovascular disease than individuals presenting with normoglycemia (4). However, a recent performed in Tangshan City, China demonstrated that the reversion of pre-diabetes to normoglycemia can minimize the future risk of cardiovascular disease and all-cause mortality. Diabetes and prediabetes increase with increasing age and have become a major problem in older adults affecting mortality and morbidity, as well as decreasing quality of life and accelerating functional decline. This data highlights the importance of implementing lifestyle interventions specifically for older Chinese adults to prevent the progression of prediabetes to diabetes, and possibly to revert pre-diabetic individuals to normoglycemia.

In our project, structured interviews, and focus groups of older patients with prediabetes, their clinical providers and their family members will be used to develop an e-health culturally modified DPP for older Chinese adults. The program will be assessed for usability, feasibility, and preliminary effectiveness. An e-health program, utilizing social technology to enable virtual engagement individually and in groups, will allow for greater ease of dissemination as well as greater use by older individuals who may not travel for in person visits and may not have the opportunity to be with other older adults socially.

Focusing on the elderly is key as age is one of the strongest risk factors for T2DM.  Using e-health allows for participants to participate from their own homes, for the participants to interact with each other and scalability of the program. The goal of this project is to, with collaborators from the Chinese team, develop an e-health DPP targeted to the population of older adults in China, to deliver it to individuals in this population and to determine whether the program decreases risk factors for T2DM. This program will be very scalable and can be offered to the large number of older Chinese at increased risk for T2DM.

The proposed project is directed toward the development of a culturally appropriate technology-enabled diabetes prevention program that will be accessible to the large majority of the older adult population, not only to those at the upper income levels. Intervention development will be guided by input from end users, which will be collected through focus groups and informant interviews to establish intervention acceptability and feasibility. The resulting e-health intervention program using social technology will be culturally informed, easily accessible to the large majority of older Chinese adults, and feasible for implementation among community dwelling older Chinese adults.  It will provide the tools for behavioral change as well as through online groups, socialization of the participants to decrease sense of isolation and increase motivation.