Cargando…

Effect of telehealth‐based versus in‐person nutritional and exercise intervention on type II diabetes mellitus improvement and efficiency of human resources utilization in patients with obesity

AIMS: Telehealth became a patient necessity during the COVID pandemic and evolved into a patient preference in the post‐COVID era. This study compared the % total body weight loss (%TBWL), HbA1c reduction, and resource utilization among patients with obesity and diabetes who participated in lifestyl...

Descripción completa

Detalles Bibliográficos
Autores principales: Rajkumar, Shruthi, Davidson, Elana, Bell, Michael, Reardon, Christina, Lapolla, Abby, Michelakis, Maria, Raftopoulos, Yannis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10551111/
https://www.ncbi.nlm.nih.gov/pubmed/37810527
http://dx.doi.org/10.1002/osp4.667
_version_ 1785115690201513984
author Rajkumar, Shruthi
Davidson, Elana
Bell, Michael
Reardon, Christina
Lapolla, Abby
Michelakis, Maria
Raftopoulos, Yannis
author_facet Rajkumar, Shruthi
Davidson, Elana
Bell, Michael
Reardon, Christina
Lapolla, Abby
Michelakis, Maria
Raftopoulos, Yannis
author_sort Rajkumar, Shruthi
collection PubMed
description AIMS: Telehealth became a patient necessity during the COVID pandemic and evolved into a patient preference in the post‐COVID era. This study compared the % total body weight loss (%TBWL), HbA1c reduction, and resource utilization among patients with obesity and diabetes who participated in lifestyle interventions with or without telehealth. METHODS: A total of 150 patients with obesity and diabetes who were followed every 4–6 weeks either in‐person (n = 83) or via telehealth (n = 67), were included. All patients were provided with an individualized nutritional plan that included a weight‐based daily protein intake from protein supplements and food, an activity/sleep schedule‐based meal times, and an aerobic exercise goal of a 2000‐calorie burn/week, customized to patient's preferences, physical abilities, and comorbidities. The goal was to lose 10%TBWL. Telehealth‐based follow‐up required transmission via texting of weekly body composition measurements and any blood glucose levels below 100 mg/dl for medication adjustments. Weight, BMI, %TBWL, HbA1c (%), and medication effect score (MES) were compared. Patient no‐show rates, number of visits, program duration, and drop‐out rate were used to assess resource utilization based on cumulative staff and provider time spent (CSPTS), provider lost time (PLT) and patient spent time (PST). RESULTS: Mean age was 47.2 ± 10.6 years and 74.6% were women. Mean Body Mass Index (BMI) decreased from 44.1 ± 7.7–39.7 ± 6.7 kg/m(2) (p < 0.0001). Mean program duration was 189.4 ± 169.3 days. An HbA1c% unit decline of 1.3 ± 1.5 was achieved with a 10.1 ± 5.1%TBWL. Diabetes was cured in 16% (24/150) of patients. %TBWL was similar in regards to telehealth or in‐person appointments (10.6% ± 5.1 vs. 9.6% ± 4.9, p = 0.14). Age, initial BMI, MES, %TBWL, and baseline HbA1c had a significant independent effect on HbA1c reduction (p < 0.0001). Program duration was longer for in‐person follow‐up (213.8 ± 194 vs. 159.3 ± 127, p = 0.019). The mean annual telehealth and in‐person no‐show rates were 2.7% and 11.2%, respectively (p < 0.0001). Mean number of visits (5.7 ± 3.0 vs. 8.6 ± 5.1) and drop‐out rates (16.49% vs. 25.83%) were lower in telehealth group (p < 0.0001). The CSPTS (440.4 ± 267.5 min vs. 200.6 ± 110.8 min), PLT (28.9 ± 17.5 min vs. 3.1 ± 1.6 min), and PST (1033 ± 628 min vs. 113.7 ± 61.4 min) were significantly longer (p < 0.0001) for the in‐person group. CONCLUSIONS: Telehealth offered comparable %TBWL and HbA1c decline as in‐person follow‐up, but with a shorter follow‐up, fewer appointments, and no‐shows. If improved resource utilization is validated by other studies, telehealth should become the standard of care for the management of obesity and diabetes.
format Online
Article
Text
id pubmed-10551111
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-105511112023-10-06 Effect of telehealth‐based versus in‐person nutritional and exercise intervention on type II diabetes mellitus improvement and efficiency of human resources utilization in patients with obesity Rajkumar, Shruthi Davidson, Elana Bell, Michael Reardon, Christina Lapolla, Abby Michelakis, Maria Raftopoulos, Yannis Obes Sci Pract Original Articles AIMS: Telehealth became a patient necessity during the COVID pandemic and evolved into a patient preference in the post‐COVID era. This study compared the % total body weight loss (%TBWL), HbA1c reduction, and resource utilization among patients with obesity and diabetes who participated in lifestyle interventions with or without telehealth. METHODS: A total of 150 patients with obesity and diabetes who were followed every 4–6 weeks either in‐person (n = 83) or via telehealth (n = 67), were included. All patients were provided with an individualized nutritional plan that included a weight‐based daily protein intake from protein supplements and food, an activity/sleep schedule‐based meal times, and an aerobic exercise goal of a 2000‐calorie burn/week, customized to patient's preferences, physical abilities, and comorbidities. The goal was to lose 10%TBWL. Telehealth‐based follow‐up required transmission via texting of weekly body composition measurements and any blood glucose levels below 100 mg/dl for medication adjustments. Weight, BMI, %TBWL, HbA1c (%), and medication effect score (MES) were compared. Patient no‐show rates, number of visits, program duration, and drop‐out rate were used to assess resource utilization based on cumulative staff and provider time spent (CSPTS), provider lost time (PLT) and patient spent time (PST). RESULTS: Mean age was 47.2 ± 10.6 years and 74.6% were women. Mean Body Mass Index (BMI) decreased from 44.1 ± 7.7–39.7 ± 6.7 kg/m(2) (p < 0.0001). Mean program duration was 189.4 ± 169.3 days. An HbA1c% unit decline of 1.3 ± 1.5 was achieved with a 10.1 ± 5.1%TBWL. Diabetes was cured in 16% (24/150) of patients. %TBWL was similar in regards to telehealth or in‐person appointments (10.6% ± 5.1 vs. 9.6% ± 4.9, p = 0.14). Age, initial BMI, MES, %TBWL, and baseline HbA1c had a significant independent effect on HbA1c reduction (p < 0.0001). Program duration was longer for in‐person follow‐up (213.8 ± 194 vs. 159.3 ± 127, p = 0.019). The mean annual telehealth and in‐person no‐show rates were 2.7% and 11.2%, respectively (p < 0.0001). Mean number of visits (5.7 ± 3.0 vs. 8.6 ± 5.1) and drop‐out rates (16.49% vs. 25.83%) were lower in telehealth group (p < 0.0001). The CSPTS (440.4 ± 267.5 min vs. 200.6 ± 110.8 min), PLT (28.9 ± 17.5 min vs. 3.1 ± 1.6 min), and PST (1033 ± 628 min vs. 113.7 ± 61.4 min) were significantly longer (p < 0.0001) for the in‐person group. CONCLUSIONS: Telehealth offered comparable %TBWL and HbA1c decline as in‐person follow‐up, but with a shorter follow‐up, fewer appointments, and no‐shows. If improved resource utilization is validated by other studies, telehealth should become the standard of care for the management of obesity and diabetes. John Wiley and Sons Inc. 2023-04-28 /pmc/articles/PMC10551111/ /pubmed/37810527 http://dx.doi.org/10.1002/osp4.667 Text en © 2023 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Rajkumar, Shruthi
Davidson, Elana
Bell, Michael
Reardon, Christina
Lapolla, Abby
Michelakis, Maria
Raftopoulos, Yannis
Effect of telehealth‐based versus in‐person nutritional and exercise intervention on type II diabetes mellitus improvement and efficiency of human resources utilization in patients with obesity
title Effect of telehealth‐based versus in‐person nutritional and exercise intervention on type II diabetes mellitus improvement and efficiency of human resources utilization in patients with obesity
title_full Effect of telehealth‐based versus in‐person nutritional and exercise intervention on type II diabetes mellitus improvement and efficiency of human resources utilization in patients with obesity
title_fullStr Effect of telehealth‐based versus in‐person nutritional and exercise intervention on type II diabetes mellitus improvement and efficiency of human resources utilization in patients with obesity
title_full_unstemmed Effect of telehealth‐based versus in‐person nutritional and exercise intervention on type II diabetes mellitus improvement and efficiency of human resources utilization in patients with obesity
title_short Effect of telehealth‐based versus in‐person nutritional and exercise intervention on type II diabetes mellitus improvement and efficiency of human resources utilization in patients with obesity
title_sort effect of telehealth‐based versus in‐person nutritional and exercise intervention on type ii diabetes mellitus improvement and efficiency of human resources utilization in patients with obesity
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10551111/
https://www.ncbi.nlm.nih.gov/pubmed/37810527
http://dx.doi.org/10.1002/osp4.667
work_keys_str_mv AT rajkumarshruthi effectoftelehealthbasedversusinpersonnutritionalandexerciseinterventionontypeiidiabetesmellitusimprovementandefficiencyofhumanresourcesutilizationinpatientswithobesity
AT davidsonelana effectoftelehealthbasedversusinpersonnutritionalandexerciseinterventionontypeiidiabetesmellitusimprovementandefficiencyofhumanresourcesutilizationinpatientswithobesity
AT bellmichael effectoftelehealthbasedversusinpersonnutritionalandexerciseinterventionontypeiidiabetesmellitusimprovementandefficiencyofhumanresourcesutilizationinpatientswithobesity
AT reardonchristina effectoftelehealthbasedversusinpersonnutritionalandexerciseinterventionontypeiidiabetesmellitusimprovementandefficiencyofhumanresourcesutilizationinpatientswithobesity
AT lapollaabby effectoftelehealthbasedversusinpersonnutritionalandexerciseinterventionontypeiidiabetesmellitusimprovementandefficiencyofhumanresourcesutilizationinpatientswithobesity
AT michelakismaria effectoftelehealthbasedversusinpersonnutritionalandexerciseinterventionontypeiidiabetesmellitusimprovementandefficiencyofhumanresourcesutilizationinpatientswithobesity
AT raftopoulosyannis effectoftelehealthbasedversusinpersonnutritionalandexerciseinterventionontypeiidiabetesmellitusimprovementandefficiencyofhumanresourcesutilizationinpatientswithobesity