Leading on from my previous blog, the NHS has now announced a plan to issue people at high risk of Type 2 Diabetes (T2DM) with what they call “wearable technology”. Most of us call these pedometers. Their more sophisticated cousins are called accelerometers. They are also known as exercise trackers.
The Diabetes Prevention Programme (DPP)1
The DPP is.an innovative and much to be welcomed NHS initiative, designed to help those at high risk of T2DM from going on to develop the disease. There are two arms to the programme:
- Those referred to the face-to-face programme get tailored, personalised help, including education on lifestyle choices, advice on how to reduce weight through healthier eating and bespoke physical activity programmes, which together “have been proven to reduce the risk of developing Type 2 diabetes”.
- Those referred to the digital arm have the same level of help, added to which are wearable technologies which monitor levels of exercise, apps which allow users to access health coaches, online peer support groups and the ability to set and monitor goals electronically.
The initial Pilot projects have been judged successful because trials of the digital DPP, involving more than 5,000 people, found that 68% referred to digital schemes took part compared with around half of those offered face-to-face support.
Where’s the evidence?
Note that “success” means that the digital arm has been found to be more popular than the face-to-face programme. There has been no comparison of the outcomes of the two arms. We all like gadgets – “boys’ toys” – and I suppose that explains the greater popularity of the digital arm. It is also reasonable to believe that if more people engage with one arm than the other, more people will benefit – presuming that the programme produces benefits in the first place.
The effectiveness of “wearable technology”
There have been a number of trials of the effectiveness of exercise trackers in encouraging increased physical activity among sedentary people. Such “trackers” come in a variety of forms with different characteristics. They can monitor movement, calories burned, heart rate and even sleep patterns.
However trackers and internet based exercise programmes have shown very limited evidence of benefit. Even when exercise adherence has increased there has been little measurable clinical benefit. Most disappointing of all, one controlled trial of weight loss strategies found that overweight people using exercise trackers lost less weight over two years than their controls who did not use trackers!
Governments like to initiate health promotion programmes with a feel-good factor, often without clear evidence of benefit. A good example has been the NHS Health Check which was rolled out across the country at great expense and increase of GP workload. So far there has been no evidence that it has done any good at all.
I fear that the same will apply to the provision of “wearable technology” to pre-diabetics. But I would be in favour of encouraging the potential recipients to buy their own machines. The more you invest in your ownhealth the more likely you are to strive to get the most out of it.