Background: DSME improves diabetes outcomes, however participation is low. Virtual world (VW) technology is a scalable and engaging platform for DSME. The WIC study compared the effectiveness of DSME Medical Group Visits conducted in a VW platform vs. in-person to improve diabetes outcomes for minority women with uncontrolled type 2 diabetes (T2DM).

Objective: To assess the impact of WIC DSME intervention on hospital use and associated costs (inpatient, observation stays, ED visits).

Methods: Hospital utilization and billing data of the WIC-DSME intervention was analyzed 6-months pre-to-post enrollment for the study cohort and by study arm for a subset of 142 minority women with T2DM who completed the study. The percent change in the number of hospital utilizations from pre-to-post enrollment was calculated and associated costs were estimated from billing data and compared by study arm, utilization type and for the cohort as a whole.

Results: Total utilization among all 142 WIC program completers decreased by 25% from 114 events (57 events per arm) in the 6-months prior to WIC enrollment to 86 events (n=38 in-person; n=48 VW) in the 6-months post-enrollment. Hospital charges also decreased from $767,730 to $601,446 (22%). Among VW DSME participants, there was a 16% reduction in total utilization compared to a 33% reduction in the in-person DSME arm. Among VW participants, there was a 46% decrease in the number of high cost utilizations (observations and inpatient) and a 36% decrease in Emergency Department (ED) visits post-enrollment. Among in-person participants, there was no change in total high cost utilizations and a 68% decrease in ED visits. Total hospital charges for the WIC in-person DSME arm decreased by $24,625 (-6%) and $141,659 (-37%) for the WIC virtual world arm.

Conclusion: Both in-person and VW DSME are associated with lower hospital utilization and costs among minority women with uncontrolled T2DM.


S. Mitchell: Speaker’s Bureau; Self; Merck Sharp & Dohme Corp. Stock/Shareholder; Self; See Yourself Health, LLC. A. Bragg: None. J.M. Howard: None. P. Gardiner: None.


National Institute of Diabetes and Digestive and Kidney Diseases (R01DK106531)

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