Quest Diagnostics Finds Success in Employer-Based Digital Diabetes Prevention Program

When employers invest in a digital diabetes prevention program (DPP), they want to see measurable clinical results and high levels of engagement. Quest Diagnostics recently demonstrated both in a partnership with Omada Health, with 62% of the participants losing weight and the average employee completing more than 25 lessons over 9 months.¹ The findings were presented at the American Diabetes Association (ADA) 79th Scientific Sessions.

Weight loss of at least 5% has been the chief measure of success since the origins of the DPP, going back to the original National Institutes of Health study that found a lifestyle intervention could prevent the onset of type 2 diabetes (T2D) in 57% of those who met the criteria for being at risk of developing the disease, a condition now known as prediabetes.²

But some who don’t quite reach the 5% weight loss threshold still make significant progress on other indicators of metabolic health, and Quest used a newer way of measuring those factors in its study, in addition to measuring weight loss.

Quest evaluated participating employees using a model for a person’s 8-year risk of developing T2D, one that combines a series of biometric markers including glycated hemoglobin (A1C), high-density lipoprotein (HDL) cholesterol, fasting glucose, and triglycerides. This 8-year risk model was presented in a 2018 paper in Diabetes Care.³

“All of the variables in the 8-year risk model shifted in a favorable direction,” Charles E. Birse, PhD, scientific director at Quest Diagnostics, said in an interview with The American Journal of Managed Care^®. Birse was the lead author of the abstract presented recently at ADA. “We felt this was a valuable new way to demonstrate the overall effect of the program,” Birse said.

The Quest program enrolled employees in a wellness program over a 3-year period, and measured key biometric markers for a year before the digital DPP began and a year after the intervention. The group’s biometric variables were trending toward developing T2D before the intervention, but the progression began to reverse as the group took part in DPP. In addition, the study found a clear relationship between the number of lessons and reduction in diabetes risk.

According to the abstract presented at ADA, the 460 participants from Quest took part in an employer-sponsored wellness program for 3 consecutive years (2016, 2017, and 2018). They had a prediabetes fasting glucose range of 100 to 125 mg/dL, A1C of 5.7% to 6.4%, and a BMI of ≥ 25 kg/m² at the end of 2017, and they took part in at least 9 sessions of the digital DPP program starting in early 2018.

Changes in biometric markers the year prior and after the intervention were as follows:

• Fasting glucose: change prior to intervention, +4.1 mg/dL; change post-intervention, —3.2 mg/dL
• A1C: change prior to intervention, +0.1%; change post-intervention, 0.0%
• HDL cholesterol: change prior to intervention, —0.3 mg/dL; change post-intervention 1.0 mg/dL
• 8-year risk of T2D: change prior to intervention, 2.0%; change post-intervention, —0.8%

For employers, measuring the value of a DPP program also involves determining whether helping employees avoid the progression to T2D also saves healthcare dollars. Quest plans to perform this analysis for the participants in its study, Birse said, and Omada has previously published findings demonstrating return on investment of its digital DPP programs.

The findings have implications for employers; a 2017 review has shown that workplace DPP interventions are most effective when they are based on an evidence-based program with minimal modifications. Omada’s program has received full recognition from the CDC, which is the standard most commercial payers look for when making reimbursement decisions.

“Poor health and high healthcare costs increasingly burden employers and employees. While few health concerns are as challenging as diabetes, behavioral change can often slow or prevent the disease if caught in the prediabetes stage,” Birse said in a statement. “Our study is significant because it suggests that robust lab screening coupled with access to digital counseling can help an individual lower risk for a sustained period after the counseling ends.”

Omada’s digital platform is being applied beyond diabetes prevention and across chronic conditions, including hypertension, depression, and anxiety. Chief Executive Officer Sean Duffy wrote last week, in a blog post announcing a $73 million round of fundraising, “Most of today’s most vexing clinical challenges and condition areas are no longer the diseases that last century’s, in-person system was designed to address—they are ongoing needs that require ongoing support.”

References

1. Birse CE, Fragala MS, Satish A, et al. Digital behavioral counseling in a workforce setting reduces 8-year risk of developing type 2 diabetes. Presented at: 79th Scientific Sessions of the American Diabetes Association; San Francisco, California; June 7-11, 2019; Abstract 77-LB.
2. Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
3. Leong A, Daya N, Porneala B et al. Prediction of type 2 diabetes by hemoglobin A1C in two community -based cohorts. Diabetes Care. 2018;41(1):60-68.. doi: 10.2337/dc17-0607.