Department of Health Law, Policy and Management, Boston University of Public Health, Boston, Massachusetts, USA.
VA Boston Healthcare System, Boston, Massachusetts, USA.
Diabetes Obes Metab. 2021 Dec;23(12):2643-2650. doi: 10.1111/dom.14515. Epub 2021 Aug 19.
To test the effectiveness of a ketogenic diet and virtual coaching intervention in controlling markers of diabetes care and healthcare utilization.
Using a difference-in-differences analysis with a waiting list control group-a quasi-experimental methodology-we estimated the 5-month change in HbA1c, body mass index, blood pressure, prescription medication use and costs, as well as healthcare utilization. The analysis included 590 patients with diabetes who were also overweight or obese, and who regularly utilize the Veterans Health Administration (VA) for healthcare. We used data from VA electronic health records from 2018 to 2020.
The ketogenic diet and virtual coaching intervention was associated with significant reductions in HbA1c (-0.69 [95% CI -1.02, -0.36]), diabetes medication fills (-0.38, [-0.49, -0.26]), body mass index (-1.07, [-1.95, -0.19]), diastolic blood pressure levels (-1.43, [-2.72, -0.14]), outpatient visits (-0.36, [-0.70, -0.02]) and prescription drug costs (-34.54 [-48.56, -20.53]). We found no significant change in emergency department visits (-0.02 [-0.05, 0.01]) or inpatient admissions (-0.01 [-0.02, 0.01]).
This real-world assessment of a virtual coaching and diet programme shows that such an intervention offers short-term benefits on markers of diabetes care and healthcare utilization in patients with diabetes.
测试生酮饮食和虚拟教练干预在控制糖尿病护理标志物和医疗保健利用方面的效果。
采用具有候补组的差分法-一种准实验方法-我们估计了 5 个月内 HbA1c、体重指数、血压、处方药物使用和费用以及医疗保健利用的变化。该分析包括 590 名患有糖尿病且超重或肥胖的患者，他们经常利用退伍军人健康管理局（VA）进行医疗保健。我们使用了 2018 年至 2020 年 VA 电子健康记录的数据。
生酮饮食和虚拟教练干预与 HbA1c 的显著降低相关（-0.69 [95% CI -1.02, -0.36]），糖尿病药物填充量减少（-0.38，[-0.49, -0.26]），体重指数降低（-1.07，[-1.95, -0.19]），舒张压降低（-1.43，[-2.72, -0.14]），门诊就诊次数减少（-0.36，[-0.70, -0.02]）和处方药费用降低（-34.54 [-48.56, -20.53]）。我们没有发现急诊就诊次数（-0.02 [-0.05, 0.01]）或住院人数（-0.01 [-0.02, 0.01]）的显著变化。
这项对虚拟教练和饮食计划的真实世界评估表明，这种干预在糖尿病患者的糖尿病护理标志物和医疗保健利用方面提供了短期益处。
