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Finding Telehealth Value in Diabetes and Obesity

The documentation is accumulating. Telehealth has been a boon for diabetes and obesity care during the pandemic. A new study in Medical Care tells us that glycemic control improved for Medicare patients when they received their care during the pandemic through telehealth. Yet another study, published yesterday in Nutrition & Diabetes, suggests that weight management tailored for patients with diabetes can help patients achieve healthier weights, better glycemic control, and, notably, improved quality of life.

But the question remains, will health systems tap into the full value of telehealth in diabetes and obesity care?

Scalable Weight Management for Diabetes

John Apolzan and colleagues published a single-arm study (i.e. no control group) of 136 patients with type 2 diabetes and BMI between 27 and 50. After 24 weeks, they saw significant improvements in HBA1c, body weight, and emotional distress from diabetes (measured by the Diabetes Distress Scale). Weight-related quality of life improved and patients reported experiencing less hunger, too.

In other words, this telehealth program helped people lose some weight, better control their diabetes, and feel better over the course of six months. This program is a telehealth adaptation of a Weight Watchers program tailored for patients with diabetes. In a randomized controlled trial with Weight Watchers in a face-to-face care setting, efficacy for glycemic control and weight management was evident.

Of course, the present study did not have a control group, so regression to the mean could explain some of the improvements seen. But this study offers encouragement that telehealth can be valuable for these patients.

Telehealth for Diabetes Care

In the other new study, Brigham Walker and colleagues analyzed the medical records of Medicare patients in Louisiana with type 2 diabetes. Using propensity score–weighting strategy with regression controls for baseline characteristics, they compared outcomes for patients with and without telehealth care. The authors of this study tell us:

“Among patients using telehealth in the COVID-19 pandemic era, about half used telehealth only once. After balancing on baseline covariates, telehealth was found to be associated with generally better patient outcomes (eg, better HbA1c control, lower LDL and BP levels, and more instances of normal BMI).”

Value to Claim

Clearly, telehealth has value to offer, but health systems innovate very slowly. CMS has been resistant to incorporate telehealth into care delivery for Medicare in diabetes. It has left virtual program out of the Diabetes Prevention Program, despite evidence that they can be effective.

Because of this and other implementation problems, the Medicare Diabetes Prevention Program is far from living up to its potential. We have a tool for doing better with telehealth. Let’s put it to better use.

Click here for the Apolzan study and here for the Walker study. For more on policies and programs for diabetes prevention, click here.

Computer Screen Codes, image by Techfiesta, licensed under CC BY-SA 4.0

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April 7, 2023