Yhdysvaltain Veterans Health Administration seuraa tarkoin niiden veteraanien terveyttä, joiden hoitoa se rahoittaa. Virasto ostaa diabeetikkkoveteraaneille Virta Healthin virtuaaliklinikan palvelut, joiden kiinisestä vaikuttavuudesta ja ja vaikutuksesta hoitokustannuksiin se julkisti eilen uuden tutkimuksen. Tarkastelujakso oli nyt kaksi vuotta. Aikaisemmin on julkistettu vastaava viiden kuukauden jaksolta.
Arviot:
Kliininen vaikuttavuus: kohtalainen.
Hoitokustannuksia pienentävä vaikutus: kohtalainen.
https://pubmed.ncbi.nlm.nih.gov/38082469/Lainaa:
2023 Dec 11. doi: 10.1111/dom.15401. Online ahead of print.
Clinical effectiveness and cost-impact after 2 years of a ketogenic diet and virtual coaching intervention for patients with diabetes
Kiersten L Strombotne , Jessica Lum , Steven D Pizer, Stuart Figueroa, Austin B Frakt, Paul R Conlin
DOI: 10.1111/dom.15401
Abstract
Aim: We previously evaluated the impacts at 5 months of a digitally delivered coaching intervention in which participants are instructed to adhere to a very low carbohydrate, ketogenic diet. With extended follow-up (24 months), we assessed the longer-term effects of this intervention on changes in clinical outcomes, health care utilization and costs associated with outpatient, inpatient and emergency department use in the Veterans Health Administration.
Materials and methods: We employed a difference-in-differences model with a waiting list control group to estimate the 24-month change in glycated haemoglobin, body mass index, blood pressure, prescription medication use, health care utilization rates and associated costs. The analysis included 550 people with type 2 diabetes who were overweight or obese and enrolled in the Veterans Health Administration for health care. Data were obtained from electronic health records from 2018 to 2021.
Results: The virtual coaching and ketogenic diet intervention was associated with significant reductions in body mass index [-1.56 (SE 0.390)] and total monthly diabetes medication usage [-0.35 (SE 0.054)]. No statistically significant differences in glycated haemoglobin, blood pressure, outpatient visits, inpatient visits, or emergency department visits were observed. The intervention was associated with reductions in per-patient, per-month outpatient spending [-USD286.80 (SE 97.175)] and prescription drug costs (-USD105.40 (SE 30.332)].
Conclusions: A virtual coaching intervention with a ketogenic diet component offered modest effects on clinical and cost parameters in people with type 2 diabetes and with obesity or overweight. Health care systems should develop methods to assess participant progress and engagement over time if they adopt such interventions, to ensure continued patient engagement and goal achievement.
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