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Intent-to-treat analysis of a simultaneous multisite telehealth diabetes prevention program
  1. Elizabeth L Ciemins1,2,
  2. Patricia J Coon1,
  3. Nicholas C Coombs1,
  4. Barbara L Holloway1,
  5. Elizabeth J Mullette1,
  6. William N Dudley3
  1. 1Center for Clinical Translational Research, Billings Clinic, Billings, Montana, USA
  2. 2AMGA (formerly American Medical Group Association), Alexandria, Virginia, USA
  3. 3Department of Public Health Education, University of North Carolina-Greensboro, Greensboro, North Carolina, USA
  1. Correspondence to Dr Elizabeth L Ciemins; eciemins{at}


Objective Determine 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 methods A 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.

Results Between 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.

Conclusions Using 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.

  • telemedicine
  • rural health
  • prevention
  • type 2 diabetes

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  • ELC and PJC contributed equally.

  • Contributors ELC and PJC contributed to study design, project oversight, data analyses and writing the manuscript. BLH led all program activities and reviewed and edited the manuscript. EJM contributed to the discussion, draft and editing of the manuscript. NCC conducted all statistical analyses. WND provided oversight for all statistical analyses and reviewed the manuscript. ELC and PJC are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding Funding for this study was provided by the US Department of Health and Human Services’ Health Resources and Services Administration’s (HRSA) Office for the Advancement of Telehealth (OAT) (Grants: 1 H2AIT16620-01-00; 5 H2AIT16620-02-00; and 5 H2AIT16620-03-00), the Montana IDeA Network of Biomedical Research Excellence (INBRE) (Grant G129-15-W4874). The project that contributed the urban data was supported by the State of Montana and by the Grant or Cooperative Agreement Number, NU58DP004818, funded by the Centers for Disease Control and Prevention.

  • Disclaimer The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention, the Department of Health and Human Services, or Montana INBRE.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Billings Clinic IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional unpublished data from the study are available.

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