But when you examine the evidence of what is having a real impact on health, virtual coaching apps and services show the biggest impact for the future. Many of these services began by adopting the successful in-person diabetes prevention program from the Center for Disease Control in the US and implemented through the YMCA. With the growing epidemic of diabetes in the US and the trend toward this beginning in Europe, preventing diabetes has become a public health priority.
With successful adoption of these by employers and insurers in the US, these programs are expanding to other chronic conditions. Several factors lead me to the conclusion that this type of digital health will have the largest impact:
- evidence-based behavior change techniques;
- ease of use – because these programs are part of secure apps, the pervasiveness of smartphones makes them easily accessible;
- personalization – the use of virtual coaches, particularly when multiple languages and culture sensitivity is addressed, makes the nudges more personal and less one-size-fits-all;
- business model – most of these apps have contracted initially with employers who are seeking to reduce their medical costs and want to have a healthier workforce. One company promised only to charge if they were effective. Health insurers seeing the effectiveness of these programs are also willing to pay for their virtual coaching services;
- use of remote monitoring – most of these services are now offering remote monitoring devices including wireless scales, blood pressure monitors, and glucose monitors to better track progress;
- outcomes – the best companies in this space have done clinical trials on their programs and published them in peer-reviewed journals showing a significant reduction in HbA1c and weight as well as other positive outcomes. One even published a study in the US Medicaid population, which did not show a significant difference. This kind of transparency is refreshing and I hope it will continue.
The programs have shown significant growth; most now service hundreds of thousands or even millions of consumers. Of course, with an estimated 34 million in the US with diabetes and 88 million with pre-diabetes, this kind of scale matters. (CDC, 2020).
The WHO estimates 60 million people with diabetes within its member countries. However, the adoption of virtual coaching in Europe is at an earlier stage. One limitation of growth is the number of available coaches. Although there are training programs based on diabetes educators, will these companies shift to using AI-driven chatbots to meet the demand? Some are already working on it.