Upgrading Canary Coaches Diabetes Prevention Services

By Neal Kaufman, MD, MPH l General Manager, Canary Coaches


Over the 12 years since we first launched our digital Diabetes Prevention Program (DPP), we have annually made significant improvements in our approach based on changes in the DPP curriculum and advances in the digital delivery of interventions. We are currently engaged in a major upgrade and I am proud to share some of our approach to ensure we both constantly improve the entire experience, and continue to make it engaging and relevant for all participants.


Digital therapeutics such as our virtual, CDC-recognized, Diabetes Prevention Program (DPP) have the capacity to transform people’s lives and extend their health span. Outcomes are optimized if the interventions are designed and deployed in ways that are faithful to the principles upon which the intervention has been proven effective.   CDC-recognized DPP interventions included in the National DPP are based on the NIH’s 2002 ground breaking study which demonstrated that 12 months of intensive lifestyle support focusing on eating healthy and being active, and using an incremental small steps approach with reinforcement from a skilled coach, was able to lower the progression from pre-diabetes to type 2 diabetes.


Between 2006 and 2008 we had the honor to be the technology team working with the original creators of the intensive lifestyle limb of the NIH’s DPP study (University of Pittsburgh’s faculty) to create the first ever digital DPP service.  A lot has changed since then, especially in the way digital delivery of proven-effective interventions have become more effective and more widely available.


This year’s enhancements will be informed by 2 key observations.


  1. Individuals are much more likely to adopt and sustain health-promoting behaviors if they have the confidence (self-efficacy) that they can set a goal and accomplish it. Fortunately, once a person has increased their confidence regarding their ability to succeed with one or two small and attainable goals, they are usually able to tackle harder and more challenging goals.  Our enhancements will be infused with self-efficacy principles and activities.  This effort will benefit from the life’s work of our partner, Dr. Kate Lorig and her colleagues at the Self-Management Resource Center. Examples of enhancements based on increasing participants’ self-efficacy include: lessons which allow the participant to self-tailor their experience; participant interactions with their coach which acknowledge the participants’ success in solving a problem or successfully completing their weekly action plan; and moderated chats which encourage participants to model the healthy behaviors other participants do.
  2. Designing any intervention, but especially one that is delivered digitally to individuals with a variety of backgrounds and characteristics, requires inclusion of a range of voices in all aspects of the development and deployment process. This has been highlighted in the past months with the increased awareness of the need to overcome systemic racism, prejudice, and stereotyping that is at the core of the Black Lives Matter movement. To that end, we have made our design and review processes more inclusive by asking for and listening to a wide variety of voices and perspectives. We will also monitor the differential impact of our service on individuals based on their race/ethnicity, social economic status, etc. As we enhance our digital DPP service to be effective with various audiences, for example, the Medicaid Population, this has become all the more important to our efforts and success.


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