PT  - JOURNAL ARTICLE
AU  - Elizabeth L Ciemins
AU  - Patricia J Coon
AU  - Nicholas C Coombs
AU  - Barbara L Holloway
AU  - Elizabeth J Mullette
AU  - William N Dudley
TI  - Intent-to-treat analysis of a simultaneous multisite telehealth diabetes prevention program
AID  - 10.1136/bmjdrc-2018-000515
DP  - 2018 Apr 01
TA  - BMJ Open Diabetes Research & Care
PG  - e000515
VI  - 6
IP  - 1
4099  - http://drc.bmj.com/content/6/1/e000515.short
4100  - http://drc.bmj.com/content/6/1/e000515.full
SO  - BMJ Open Diab Res Care2018 Apr 01; 6
AB  - 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.