Hybrid Model of Intensive Lifestyle Intervention for Patients with Diabetes & Obesity for Post-COVID Era

Abstract

ObjectivesThe Weight Achievement and Intensive Treatment (Why WAIT) program is a 12-week multidisciplinary intensive lifestyle intervention (ILI) program for diabetes and weight management. We previously showed that the in-person model (iPM) of ILI has led to long-term maintenance of 6.9% weight loss for up to 10 yrs in real-world clinical practice. With the advent of the COVID-19 pandemic, we reported that a totally virtual model (VM) of the ILI program for the same duration was equally effective in reducing body weight and improving glycemic control. In this study, we test a newly introduced hybrid model (HM), combining 2 in-person sessions with 10 virtual sessions, to accommodate the prolonged restrictions of an ongoing pandemic.MethodsWe evaluated 46 participants (age 57 ± 11 yrs; 52% females, 30% with type 1 diabetes) who enrolled in HM (n = 8; A1C 6.79 ± 0.97%; BMI 32.7 ± 6.7 kg/m2), VM (n = 16; A1C 7.73 ± 1.32%; BMI 33.5 ± 6.4 kg/m2) and iPM (n = 22; A1C 7.98 ± 1.09%; BMI 36.1 ± 5.1 kg/m2) of the ILI program.ResultsAt 12 weeks, body weight decreased from baseline in all three groups: mean reduction in HM (−7.46 ± 3.77 kg; p = 0.001), VM (−7.48 ± 3.65 kg; p < 0.001), and iPM (−6.89 ± 3.54 kg; p < 0.001). Moreover, A1C decreased from baseline in all three groups: mean reduction in HM (−0.44 ± 0.54%; p = 0.055), VM (−1.03 ± 1.1%; p = 0.002), and iPM (−1.00 ± 1.2%; p = 0.001). There were no significant differences in body weight reduction (p = 0.89) or A1C (p = 0.5) between groups. Furthermore, analysis of CGM data showed percentage Time-in-Range (%TIR) [70–180 mg/dL] at the end of each program was 82 ± 12% in HM, 87 ± 14% in VM, and 72 ± 23% in iPM, with no significant differences between groups (p = 0.3). Blood pressure, lipid profile, and number of anti-hyperglycemic medications also showed no significant differences between groups.ConclusionsIn conclusion, a hybrid model of the Why WAIT program is as effective as the virtual and the in-person models in reducing body weight and A1C after 12 weeks. Given its easy scalability, a hybrid model could potentially be offered to a larger number of patients with diabetes and obesity who may benefit from its increased flexibility and enhanced accountability without compromising the multidisciplinary team approach in post-COVID era.Funding SourcesFunded internally at Joslin Diabetes Center.