Introduction and Objective: Virtual environments may enhance social support through interactive and immersive engagement; however, evidence of their long-term impact remains limited. This study aims to examine the effect of a 3D virtual diabetes self-management education and support (DSME/S) intervention (Learning in a Virtual Environment [LIVE]) on perceived social support and its association with behavioral and metabolic outcomes over 12 months.Methods: This secondary analysis used data from a 52-week, multi-site, randomized controlled trial (N=211) comparing LIVE with a web-based DSME/S control. Perceived social support) was measured at baseline, 3, 6, and 12 months using the Diabetes Support Scale. Behavioral (exercise monitoring, physical activity, foot care, and glucose monitoring), dietary, and metabolic outcomes (HbA1c, lipids, blood pressure, BMI, and waist circumference) were assessed. Hierarchical linear mixed models were used to evaluate longitudinal associations. All analyses were performed using STATA version 14.Results: Participants (mean age 58.9±10.1 years; 59% female) demonstrated increases in perceived social support over time in both groups, with greater gains in the LIVE group at 6 months. Higher perceived social support was significantly associated with improved foot care (β=0.02, p < 0.05) and lower diastolic blood pressure (β=0.05, p < 0.05). Social support also moderated trajectories of exercise monitoring and physical-activity intensity over time. No consistent associations were observed between HbA1c levels and most dietary outcomes.Conclusion: Enhanced perceived social support in a 3D virtual DSME/S (LIVE) platform was associated with improvements in key self-management behaviors and blood pressure levels. These findings suggest that immersive digital interventions may strengthen behavioral pathways that influence cardio metabolic risk, even in the absence of short-term glycemic change.
E.A. Adawudu: None. A. Vorderstrasse: None. G. Melkus: None.
National Institutes of Health, National Heart, Lung, Blood Institute (1R01-HL118189-01)
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