Digital Health Tools and Behavioral Strategies to Increase Engagement With Diabetes Self-Management Education and Support

Design and Feasibility of DM-BOOST

Amante, Daniel J. PhD, MPH
Shenette, Lisa MS, RD, LDN
Wainaina, Stacey BS
Balakrishnan, Kavitha BS
Bhatia, Shina MS
Lee, Jung Ae PhD, MS
Lemon, Stephenie C. PhD, MS
McManus, David MD, MS
Harlan, David M. MD
Malkani, Samir MD
Gerber, Ben S. MD, MPH

Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts
Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts
Diabetes Center of Excellence, UMass Chan Medical School, Worcester, Massachusetts
Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts
Diabetes Center of Excellence, UMass Chan Medical School, Worcester, Massachusetts
Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts

Daniel J. Amante, Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Ave North, Worcester, MA 01655, USA. Email: [email protected]

The Science of Diabetes Self-Management and Care 50(6):p 497-509, December 2024. | DOI: 10.1177/26350106241285829

Purpose

The purpose of the study was to describe the development and feasibility of implementing the DM-BOOST program in support of an established diabetes self-management education and support (DSMES) program.

Methods

A patient panel of 4 adults with type 2 diabetes (T2DM) codesigned DM-BOOST. DM-BOOST is a patient-focused program that includes peer-written text messages about diabetes self-management behaviors and digital health training to improve patient portal use and initiate goal setting prior to a scheduled DSMES appointment. Adults with T2DM and A1C ≥8.0% participated in a 6-month feasibility pilot. Participants were randomly assigned (1:1) to receive either DM-BOOST or usual care. Outcomes included DSMES engagement (scheduled and attended DSMES appointments) and changes in diabetes self-efficacy and treatment satisfaction.

Results

Pilot participants (n = 60) were 60.0% female with mean age 45.5 years (SD 8.3) and A1C 10.1% (SD 1.8%). All DM-BOOST participants (30/30, 100%) had DSMES appointments scheduled compared to 86.7% of usual care (26/30). DM-BOOST participants had fewer DSMES appointment no-shows/cancellations (3/30, 10%) compared to usual care (10/26, 35%). There was greater improvement in diabetes self-efficacy in the DM-BOOST group compared to usual care and no difference in treatment satisfaction.

Conclusions

DM-BOOST, leveraging peer-written text messaging and digital health training, increased DSMES engagement. Implementation of DM-BOOST was determined to be feasible, with several system-level barriers identified, including obtaining provider referrals and scheduling appointments. An effectiveness trial of DM-BOOST is needed to evaluate the impact on clinical outcomes.