Photo Credit: Chinnapong
Diabetes can be a challenging condition to manage, even with perfect conditions, but this is even more true for those working with limited resources.
About one in ten individuals in America live with diabetes—between 90% and 95% of whom have type 2 diabetes (T2D). Diabetes can be a challenging condition to manage even with perfect conditions, but this is even more true for those working with limited resources. Research shows access to healthcare facilities and diabetes specialists, as well as a lack of health insurance, impact how effectively these patients can manage their condition.
Several interventions have emerged to address the needs of individuals, such as connecting people with solutions that work best for them that are commensurate with their available resources and considering barriers created by social determinants of health. This strategy has proven challenging. Our digital patient engagement platform, Pack Health, has seen a surge in the use of its virtual services since the COVID-19 pandemic began in 2020. The platform includes one-to-one health coaching, wherein digital Health Advisors work with patients to navigate their health goals. Throughout this time, we have addressed patient needs through person-to-person health coaching supplemented by digital delivery of evidence-based resources.
As we see the importance of meeting patients where they are, our team continuously seeks to understand if its condition-specific programs improve the health of its members. Through a research study, we examined how our digital health coaching program could be effective for members with T2D who live in rural areas by measuring the outcomes of these members and comparing their data with those who live in non-rural areas over six months.
Our study assessed self-reported outcome measures, such as health self-efficacy and diabetes distress, and objective measures, such as HbA1c scores. At the same time, participants received access to a personalized health coaching program tailored for individuals with T2D. During the program, participants and their Health Advisors communicated weekly via email, text, or phone and discussed topics relevant to their condition, including goal setting and medication management.
By month 6, program members improved their HbA1c by 13%, decreased diabetes distress by 22%, and increased weekly exercise minutes by 34%. Results showed that the digital health coaching intervention was as effective for individuals with T2D living in rural areas as it was for those living in non-rural areas. With these promising results, it seems logical to conclude that patients in rural areas who are given additional support to manage their needs and ease barriers to care will improve their health outcomes as much as patients in nonrural communities.
Access to nutritious foods is an additional factor that impacts how patients with T2D manage their condition. Nearly 15 million households in the US report food insecurity, which can be particularly troublesome for populations dealing with metabolic conditions. Pack Health has incorporated providing healthy food to its members who deal with these issues. In 2023, it piloted a program with Blue Cross and Blue Shield of North Carolina to test whether a combination of digital health coaching and biweekly medically tailored grocery box delivery services could impact its members with T2D. Halfway through the 6-month program, the average diabetes distress score among participants had decreased by 31%, and the average food security score improved by 53%.
For specific populations in rural areas, food insecurity compounds the lack of access to care, contributing to poorer outcomes, including worse glycemic control and increased healthcare use. Our services and the results of our member’s experience demonstrate addressing basic needs, like access to healthy food, can provide improved clinical and QOL outcomes. In a secondary analysis, the impact of a tailored digital health coaching program and bi-weekly food delivery on individuals with T2D who live in a rural area and experience food insecurity was just as strong. More than that, exercise minutes among participants increased by more than 200%.
We know that keeping patients engaged in their healthcare is important. More than that, helping individuals alter their lifestyles to improve their health may lower costs of diabetes care overall—for which the United States spent over $300 billion in 2022.
Health coaching has the potential to transform healthcare and break down barriers for those lacking access to the resources they need. With widespread adoption, individuals with diabetes and so many other chronic conditions can see real, measurable impacts.
