An innovative new coaching app is taking on the fight against type 2 diabetes in the UK. Dr Roger Henderson, Medical Director of Liva Healthcare, tells us why it has victory in its sights.
Liva is a next-generation digital platform that puts prediabetes and diabetes patients in touch with a personal coach who provides tailored advice on lifestyle changes that can reverse or halt the progression of their condition. Patients are referred to the smartphone-based system by their GP and receive regular online coaching sessions, as well as additional support where necessary, to ensure that new behaviours and habits stick. Throughout the programme, patients are appraised and assessed and their progress audited, with all information being fed back to their GP.
Type 2 diabetes is a lifestyle disease
Danish- and UK-based company Liva Healthcare was selected by NHS England out of 130 potential service providers, and the innovative platform is now being rolled out as part of the Healthier You: NHS Diabetes Prevention Programme (NDPP), which is intended to help patients stop or delay onset of type 2 diabetes by providing education on lifestyle choices and bespoke physical activity programmes.
“Lifestyle change is vital to reducing the burden of type 2 diabetes,” Dr Roger Henderson, Medical Director of Liva Healthcare, tells Health Europa Quarterly. “It has been said that if all the type 2 diabetics in the UK were to come down to a healthy weight overnight, at a stroke half of them would be able to stop taking their medication – the impact would be that dramatic.”
One in six UK hospital patients has diabetes, which costs over £10bn (~€11.6bn) every year to treat. As roughly 80% of that cost is spent on treating complications, preventing type 2 diabetes from developing or progressing in the first place would result in significant short- and long-term savings to the healthcare system.
The NDPP is proof that guided lifestyle interventions can help to reduce obesity – one of the key drivers of type 2 diabetes. Recent figures show that the 17,000 people who completed the programme lost 59,000kg between them – or 3.4kg on average, over one kilogram more than originally predicted.
Liva has proven success
Already, the Liva platform is echoing this success. Rollouts in other parts of the world have demonstrated impressive results after just six months using the platform:
- More than two-thirds (67%) of patients achieve a reduction in their HbA1c levels (average blood glucose levels)
- Close to half (48%) of prediabetic patients reverse their prediabetes
- Patients lose 5.7kg on average – and maintain the loss after 18-20 months.
All of this, notes Henderson, is without any kind of medication increase – in fact, many Liva
users can stop taking their medication while using the platform.
“Success breeds success,” Henderson says. “Patients know Liva is working for them because they can see the weight coming off, their HbA1c levels falling, their medication reducing – they can see exactly how the programme is benefitting them.”
No patient left behind
The Liva programme is built around 12 months of weekly (Q1), biweekly (Q2) and monthly (Q3,4) sessions between the patients and their coach, beginning with a one-hour meeting that takes place either face to face or via live video.
Henderson believes this initial session – during which the patient can set out their goals and expectations – is central to the success of the system and a key reason for its high retention rate: “That really allows the coach and patient to get to know one another and build a relationship, which makes the patient less likely to fall out of step with the platform later on.”
He also credits Liva’s lower-than-expected drop-out rate to its ‘traffic light’ patient system. Each coach is responsible for as many as 400-600 patients, but the platform’s intuitive, user-friendly dashboard allows them to easily spot which of their patients are struggling to make progress or else not interacting with the app as expected, and get in touch with them to provide extra support.
“From an early stage we recognised that some patients might be resistant to change or find it difficult to adjust their diet or exercise regime – those patients are flagged up by the app every day to ensure they aren’t missed by their coach,” Henderson says.
“Some digital health apps abandon the patient once they’ve been set up or only last a few weeks or months. Right from the get-go, one of the driving forces behind Liva has been to ensure that no one is hung out to dry or left to their own devices. That’s why there is constant two-way feedback between the patient and their coach throughout the whole course of the year.”
Is the UK ready to embrace digital?
UK Health Secretary Matt Hancock has extolled the virtues of digital technologies as a means of improving health and strengthening healthcare delivery, but data privacy concerns and questions over digital literacy have raised some doubts as to whether the nation is ready to embrace digital healthcare. For Henderson, it’s a no-brainer.
“As a GP, the one thing I never have enough of is time, so anything that frees up my schedule is to be recommended,” he says. “From a patient’s point of view, Liva and similar digital health technologies allow them to take control of their condition and reduce their dependence on medication, something that is striking a big chord with patients in a way that it didn’t 10 or 15 years ago. Today’s patients would much rather make lifestyle changes themselves under the supervision of a healthcare professional than they would simply take a pill prescribed to them by a doctor operating in the old-school, top-down patriarchal medical model.
“Healthcare professionals, too, would prefer patients lose weight or get fitter with their help than prescribe medication. Medication works well, but it has limitations and is no substitute for prevention. Finally, I think, the Department of Health and NHS England get this and so are embracing things like Liva, which is great to see.”
Liva gives patients a fighting chance of managing or reversing their (pre)diabetes. As its rollout continues, time will tell whether it can go far enough to stem the epidemic facing the UK, which boasts one of the highest rates of obesity in Europe. But, so far, all signs are positive.
Dr Roger Henderson
Please note, this article will appear in issue 10 of Health Europa Quarterly, which will be available to read in July 2019.