Telemedicine Intervention Effects on Waist Circumference and Body Mass Index in the IDEATel Project

Abstract

Background:

We examine the changes in waist circumference (WC) and body mass index (BMI) in older adults enrolled in a diabetes telemedicine program. The subjects were elderly Medicare beneficiaries participating in the rural (upstate New York) cohort of Informatics and Diabetes Education and Telemedicine, a randomized, controlled trial using telemedicine to improve diabetes care in which the primary outcome was glycemic control.

Methods:

Ninety-two percent of the subjects had BMI >25 kg/m², and 65.8% had a BMI ≥30 kg/m². Intervention subjects received home televisits with a dietitian or nurse educator every 4–6 weeks. Blood glucose and blood pressure values were reviewed, and lifestyle and medication changes were recommended. Non-intervention subjects received usual care through their primary care physicians. Change in WC, BMI, diet, and exercise behaviors and knowledge were examined at baseline and 12 and 24 months. A mixed-effects path analysis was performed to examine direct and indirect effects.

Results:

The telemedicine participants increased diet and exercise knowledge over time (P < 0.001). It was estimated that women in the telemedicine group reduced their WC over the 2 years by 1.2 cm, whereas women in the usual care group increased their WC by almost 1 cm (P = 0.02). Path analysis demonstrated that the intervention, through improved diet and exercise knowledge, was related to the decrease in WC (P = 0.006) and BMI (P = 0.004).

Conclusions:

Diabetes case management using telemedicine improved self-reported diet and exercise knowledge, practices, and behaviors, which in turn was associated with reductions in WC and BMI at 2 years.