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

Abstract

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. A total of 150 patients with obesity and diabetes who were followed every 4-6weeks 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 100mg/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). Mean age was 47.2±10.6years and 74.6% were women. Mean Body Mass Index (BMI) decreased from 44.1±7.7-39.7±6.7kg/m2 (p<0.0001). Mean program duration was 189.4±169.3days. 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±267.5min vs. 200.6±110.8min), PLT (28.9±17.5min vs. 3.1±1.6min), and PST (1033±628min vs. 113.7±61.4min) were significantly longer (p<0.0001) for the in-person group. 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.