Intent-to-treat analysis of a simultaneous multisite telehealth diabetes prevention program

Abstract

ObjectiveDetermine the effectiveness of a 16-week modified diabetes prevention program (DPP) administered simultaneously to multiple rural communities from a single urban site, as compared with a similar face-to-face intervention. A 12-week intervention was evaluated to consider minimization of staff costs in communities where resources are limited.Research design and methodsA prospective cohort study compared DPP interventions implemented in rural (via telehealth technology) and urban (face-to-face) communities using an intent-to-treat analysis. Primary outcome measures included 5% and 7% body weight loss. Logistic regression analyses were used to determine predictors of intervention success and included a variable for treatment effect.ResultsBetween 2010 and 2015, up to 667 participants were enrolled in the study representing one urban and 15 rural communities across Montana. The 16-week urban and rural interventions were comparable; 33.5% and 34.6% of participants lost 7% body weight, respectively; 50% and 47% lost 5% (p=0.22). Participants who were male (OR=2.41; 95% CI 1.32 to 4.40), had lower baseline body mass index (OR=1.03; 95% CI 1.01 to 1.07), attended more sessions (OR=1.33; 95% CI 1.11 to 1.58), and more frequently reported (OR=3.84; 95% CI 1.05 to 14.13) and met daily fat gram (OR=4.26; 95% CI 1.7 to 10.6) and weekly activity goals (OR=2.46; 95% CI 1.06 to 5.71) were more likely to meet their 7% weight loss goal. Predictors of meeting weight loss goals were similar for participants enrolled in the 12-week intervention.ConclusionsUsing telehealth technology to administer a modified DPP to multiple rural communities simultaneously demonstrated weight loss results comparable to those in a face-to-face intervention. Given the limitation of resources, linking rural areas to urban centers using telemedicine may increase access to much needed services to prevent or delay progression to diabetes.

Burden and management of type 2 diabetes in rural United States

“…In the ENHANCED randomized controlled trial, a dietician nutritionist‐led telemedicine program resulted in improvement in diabetes care measures (haemoglobin A1c <8%, blood pressure <140/90 mmHg, tobacco cessation, statin use, and aspirin use appropriate) compared to the control arm 63 . Importantly, studies have shown that telemedicine delivery of a T2DM prevention program was non‐inferior to an in‐person program, suggesting that telemedicine could become an important mechanism to deliver care in areas with reduced access to providers 64,66 . These results require replication in other cohorts, but are reassuring for providers and facilities implementing telemedicine based care for rural patients.…”

An intervention study on a hospital-community integrated management model of tobacco dependence based on a community intervention trial

“…If smokers did not attend the follow-up, their ACSD at the most recent follow-up was used as the outcome of the current follow-up, as was their smoking cessation status. Related studies have shown that using ITT followed by analysis leads to conservative results ( 23 , 24 ).…”

Community Health Programs Delivered Through Information and Communications Technology in High-Income Countries: Scoping Review

“…Of the 83 programs, 16 (19%) were either delivered to groups of participants or included a component that involved groups of participants. Of these 16 programs, 5 (31%) targeted diabetes education, self-management, and behavior change coaching [101,102,108,116,125]; 4 (25%) programs were CVD rehabilitation (secondary prevention) or counseling programs [46,47,52,53,55,57]; 4 (25%) addressed risk factors for chronic disease through education and behavior change coaching [131,132,136,141]; 1 (6%) involved group cognitive behavioral therapy (CBT) for participants experiencing insomnia [66]; 1 (6%) involved pharmacist-led group education for hepatitis C [73]; and 1 (6%) involved group education for osteoarthritis [70].…”