A pilot randomized trial of technology-assisted goal setting to improve physical activity among primary care patients with prediabetes

Abstract

Lifestyle behavior changes can prevent progression of prediabetes to diabetes but providers often are not able to effectively counsel about preventive lifestyle changes. We developed and pilot tested the Avoiding Diabetes Thru Action Plan Targeting (ADAPT) program to enhance primary care providers' counseling about behavior change for patients with prediabetes. Primary care providers in two urban academic practices and their patients with prediabetes were recruited to participate in the ADAPT study, an unblinded randomized pragmatic trial to test the effectiveness of the ADAPT program, including a streamlined electronic medical record-based goal setting tool. Providers were randomized to intervention or control arms; eligible patients whose providers were in the intervention arm received the ADAPT program. Physical activity (the primary outcome) was measured using pedometers, and data were gathered about patients' diet, weight and glycemic control. A total of 54 patients were randomized and analyzed as part of the 6-month ADAPT study (2010-2012, New York, NY). Those in the intervention group showed an increase total daily steps compared to those in the control group (+ 1418 vs - 598, p = 0.007) at 6 months. There was also a trend towards weight loss in the intervention compared to the control group (- 1.0 lbs. vs. 3.0 lbs., p = 0.11), although no change in glycemic control. The ADAPT study is among the first to use standard electronic medical record tools to embed goal setting into realistic primary care workflows and to demonstrate a significant improvement in prediabetes patients' physical activity.

Keywords: Applied informatics; Behavior change; Clinical decision support; Electronic health records; Goal setting; Medical informatics; Prediabetes; Primary care.

Fig. A

Screenshot of the ADAPT alert.

Fig. B

Screenshot of the ADAPT EMR goal setting tool.

Fig. C

Screenshot of ADAPT order set.

Fig. 1

Study flow.

Fig. 2

Individual and overall 7 day step average by study visit and group Fig. 1: Changes in 7-day step average from baseline to 6-month visit. Solid lines represent individual patient changes in each group; dashed lines represent overall group change. (NY, NY 2010–2012).