Stanford's Kate Lorig: Digital system for diabetics designed with, for patients


Diagnosis, treatment and management of diabetes continues to be a focal point for the use of digital health technologies, from new apps to devices that can provide improved blood sugar measurement.

Research published earlier this year from the Stanford University School of Medicine highlights how an online, self-management program can provide benefits to patients by focusing on medication adherence and exercise prompts; benefits include lower blood sugar levels and reduced depression, according to researchers.

The six-month study was initiated by the National Council on Aging (NCOA), in partnership with Anthem, BMS Foundation, Y-USA and OASIS Institute. It involved more than 1,000 participants with type 2 diabetes.

FierceMobileHealthcare reached out to lead researcher Kate Lorig (pictured right), director of the Stanford Patient Education Research Center, for more insight on the research and the impact mHealth is having on chronic disease treatment.

FierceMobileHealthcare: The study appears to call for broader clinical acceptance of digital health self-management. Why hasn’t that expanded or taken deeper root?

Kate Lorig: Unfortunately, because the Internet is a mixed bag of information, there tends to be skepticism by healthcare professionals of all Internet health content. Just as there are good and not-so-good self-help health books, the same is true of the Internet. We have to work harder to help health professionals separate the wheat from the chaff.

FMH: Of your findings, which one is the most compelling for the provider and for the patient dealing with diabetes management?

Lorig: I think there are two. The first is that A1c, a marker for the average blood sugar, decreased. This was especially true for people whose diabetes was most out of control (the program lowered A1c by 0.93 percent and lowered the percent of participants with A1c levels greater than or equal to 9 from 20 percent to 15.3 percent). Secondly, depression decreased. Depression is one of the major problems for people with diabetes because it acts as in inhibitor on their abilities to both manage their diabetes and enjoy life.

FMH: One of the challenges in empowering patients with mobile tools is commitment to the tool (as service tends to drop off). Is there any data on what can help eliminate that challenge?

Lorig: Including social support as part of the intervention, where participants help each other, is a key feature to engagement. A second key feature is that it is not a "you should" program; rather than tell people what to do, we tell people what things might be helpful and why they might be helpful, and then structure the intervention in such a way that each individual is working on behavior changes that meet their personal needs and lifestyle. Everything they do is determined by them and not someone telling them what to do.

FMH: Did the research reveal any challenges in terms of patient use of digital tools or online programs?

Lorig: We had surprisingly few problems with people using our system. This is probably due to it being designed with and for people with diabetes, and that it has had extensive user testing with patients in the real world.

FMH: What further research would you like to see, given the results?

Lorig: I’d like to see how we can best engage people with diabetes in these programs and eliminate as many barriers as possible. For example, if we invited everyone in a clinic setting to participate in diabetes self-management education either online or in small groups, what percent of the population could we reach and what would be the overall impact?

Editor's Note: This interview has been edited for clarity and length.