■远程医疗在COVID大流行期间成为患者的必需品,并在后COVID时代演变成患者的偏好。这项研究比较了总体重减轻%(%TBWL),HbA1c降低,参与有或没有远程医疗的生活方式干预的肥胖和糖尿病患者的资源利用。
■共150名肥胖和糖尿病患者,每4-6周随访一次(n=83)或通过远程医疗(n=67),包括在内。所有患者都接受了个性化的营养计划,包括每天从蛋白质补充剂和食物中摄入基于体重的蛋白质。基于活动/睡眠时间表的用餐时间,以及每周燃烧2000卡路里的有氧运动目标,根据患者的喜好定制,身体能力,和合并症。目标是损失10%TBWL。基于远程健康的随访需要通过每周的身体成分测量和低于100mg/dl的任何血糖水平的短信进行传输,以进行药物调整。重量,BMI,%TBWL,HbA1c(%),与用药效果评分(MES)进行比较。患者不露面率,访问次数,程序持续时间,和辍学率用于根据累积的员工和提供者花费的时间(CSPTS)评估资源利用率,提供者损失时间(PLT)和患者花费时间(PST)。
■平均年龄为47.2±10.6岁,74.6%为女性。平均体重指数(BMI)从44.1±7.7-39.7±6.7kg/m2下降(p<0.0001)。平均程序持续时间为189.4±169.3天。用10.1±5.1%的TBWL实现1.3±1.5的HbA1c%单位下降。16%(24/150)的患者糖尿病治愈。%TBWL在远程医疗或面对面预约方面相似(10.6%±5.1与9.6%±4.9,p=0.14)。年龄,初始BMI,MES,%TBWL,和基线HbA1c对HbA1c降低有显著的独立影响(p<0.0001)。现场随访的程序持续时间更长(213.8±194vs.159.3±127,p=0.019)。平均每年的远程医疗和当面不显示率分别为2.7%和11.2%,分别(p<0.0001)。平均就诊次数(5.7±3.0vs.8.6±5.1)和辍学率(16.49%与25.83%)低于远程健康组(p<0.0001)。CSPTS(440.4±267.5minvs.200.6±110.8分钟),PLT(28.9±17.5minvs.3.1±1.6min),和PST(1033±628分钟vs.对于面对面组,113.7±61.4分钟)明显更长(p<0.0001)。
■远程医疗提供了与现场随访相当的TBWL和HbA1c下降百分比,但是随访时间较短,较少预约,也没有出现。如果其他研究证实了资源利用率的提高,远程健康应该成为治疗肥胖和糖尿病的标准。
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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/m2 (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.
UNASSIGNED: 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.