Virtual Multidisciplinary Lifestyle Intervention Is as Effective as the Physical Program for Patients with Diabetes and Obesity during COVID-19 Pandemic

ABSTRACT

Intensive lifestyle intervention (ILI) is essential for diabetes management. The Weight Achievement and Intensive Treatment (Why WAIT) program is a 12-week multidisciplinary weight management program that has been implemented in real-world clinical practice and has shown long-term maintenance of weight reduction for 5 years. During COVID-19 pandemic, the program went virtual using telemedicine and mobile-applications (Healthimation and Good Measures™). We evaluated the outcomes of virtual program (VP) in comparison to in-person physical program (PP). Sixteen subjects were enrolled in VP and were compared to 22 subjects who completed the last 2 PPs. Body weight decreased by -16.49±8 lbs. (-7 % ± 0.3%) from baseline in VP (p<0.001) compared to -15.2± 7.8 lbs. (-6 % ± 0.3%) in PP (p<0.001) (p= 0.6 between groups). A1C decreased by -1.03% ± 1.2% from baseline in VP (p=0.002), and by -1.0% ± 1.2% in PP (p=0.001) (p=0.9 between groups). At the end of the intervention, CGM analysis showed TIR (70-180 mg/dL) was 87%±14% in VP and 72%±23% in PP (p=0.6 between them). BP and lipid profile improved in both groups with no significant difference between them. The number of anti-hyperglycemic medications reduced by -0.9± 0.6 in VP and by -0.8± 0.8 in PP (p=0.5 between them). Among insulin-treated patients with type 2 diabetes, 5 patients (50%) in VP and 5 patients (33.3%) in PP stopped insulin at 12 wks (p=0.4 between them). Patients in VP reported reduced barriers to exercise from a score of 17.2±12.2 to 4.6±3.9 (p<0.001). In conclusion, virtual multidisciplinary ILI is as effective as the in-person physical program in improving body weight, A1C, BP, lipid profile and in reducing the number of anti-hyperglycemic medications. These results suggest that scaling the Why WAIT program in a virtual format to a larger population of patients with diabetes and obesity is potentially as successful as the costly in-person program.